Student Name _____________________________________________ Student ID or SSN _________________________
2018–2019 Verification of 2016 Income Information for Student Nontax Filers
Please return this completed form and all other required materials to:
Ottumwa Campus: Indian Hills Community College, Attn. Financial Aid, 525 Grandview Avenue, Ottumwa, Iowa 52501
Fax: 641-683-5741, Phone: 800-726-2585, ext. 5262 or 641-683-5262, email us at: OneStop@indianhills.edu
Centerville Campus: Indian Hills Community College, 721 North First Street, Centerville, IA 52544
Fax: 641-856-3158, Phone: 800-670-3641, ext. 2200 or 641-856-2143, ext. 2200 email us at: OneStop@indianhills.edu
To check the status of your documents, go to WebAdvisor and click the Financial Checklist, under the Financial Aid heading.
The instructions and certifications below apply to the student and spouse, if the student is married.
Complete this section if the student and spouse will not file and are not required to file a 2016 income tax
1. Check the box/es that applies:
The student was not employed and had no income earned from work in 2016.
The student was employed in 2016 and has listed below the names of all employers and the
amount earned from each employer in 2016. [Provide copies of all 2016 IRS W-2 forms issued
to the student and spouse by their employers]. List every employer even if the employer did not
The spouse was not employed and had no income earned from work in 2016.
The spouse was employed in 2016 and has listed below the names of all employers and the
amount earned from each employer in 2016. [Provide copies of all 2016 IRS W-2 forms issued
to the student and spouse by their employers]. List every employer even if the employer did not
If more space is needed, provide a separate page with the student’s name and ID number at the top.
List Student or Spouse’s
Name
Employer’s Name
Annual Amount
Earned in 2016
employed income
i.e. babysitting,
(Example) ABC’s Auto Body Shop
2. Provide copies of all 2016 IRS W-2 forms issued to the student and spouse, if the student is married, by
their employers.
3. If you are an Independent student, provide documentation from the IRS or other relevant tax
authority dated on or after October 1, 2017 that indicates a 2016 IRS income tax return was not filed with the
IRS or other relevant tax authority.
A request to the IRS for a Verification of Nonfiling Letter can be made using the IRS “Get Transcript Online” tool
at www.irs.gov/Individuals/Get-Transcript or by submitting IRS Form 4506-T and checking box 7.
Specify which
tax year(s) you need, and mail or fax the completed form to the IRS at the address or fax number provided in
Check here if confirmation of nonfiling is provided.
Check here if confirmation of nonfiling will be provided later.
4. Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
A hand written signature, not typed, is required.
________________________________________ ________________________
Student’s Signature
(Required) Date
________________________________________ ________________________
Spouse’s Signature
(Required if a Nonfiler) Date
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.