2019-2020 Verification of 2017 Income Information for Student Nontax Filers
Please return this completed form to Indian Hills Community College along with any other requested materials:
Fax: 641.683.5741│ Mail: IHCC Financial Aid Office, 525 Grandview Ave, Ottumwa, IA 52501
or bring to One Stop/Bennett Student Services Building
You can check your financial aid document status, print required forms, and view your financial aid award information (once available) on WebAdvisor.
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 2017 income tax return with the IRS.
Check the box/es that applies:
The student was not employed and had no income earned from work in 2017.
The student was employed in 2017 and has listed below the names of all employers, the amount earned from each
employer in 2017, and whether an IRS W-2 form or an equivalent document is provided. [Provide copies of all 2017
IRS W-2 forms issued to the student and spouse by their employers]. List every employer even if the employer did
not issue an IRS W-2 form.
The spouse was not employed and had no income earned from work in 2017.
The spouse was not employed in 2017 and has listed below the names of all employers, the amount earned from
each employer in 2017, and whether an IRS W-2 form or an equivalent document is provided. [Provide copies of all
2017 IRS W-2 forms issued to the student and spouse by their employers]. List every employer even if the
employer did not issue an IRS W-2 form.
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
Annual Amount
Earned in 2017
employed income
i.e. babysitting,
(Example) ABC’s Auto Body Shop
If you are an independent student, submit an IRS Verification of Nonfiling Letter. You can order a Verification of
Nonfiling Letter on the IRS Web site or by submitting Form 4506-T to the IRS 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 the
instructions. Dependent students who did not file a 2017 tax return do NOT have to submit an IRS Verification of
Nonfiling Letter.
____ Check here if confirmation of nonfiling is provided.
____ Check here if confirmation of nonfiling will be provided later.
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
________________________________________ ________________________
Parent’s Signature (Required for dependent students) Date
WARNING: If you purposely give false or
misleading information, you may be fined,
sent to prison, or both.