2020–2021 V5 Verification
Worksheet
Dependent Student
THIS DOCUMENT CANNOT BE FAXED OR EMAILED
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law
says that before awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your
FAFSA. To verify that you provided correct information the financial aid office at your school will compare your FAFSA with the
information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to
be corrected. You and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form
and other required documents to the financial aid office at your school. YOUR SCHOOL MAY ASK FOR ADDITIONAL
INFORMATION. If you have questions about verification, contact your financial aid office as soon as possible so that your financial
aid will not be delayed.
A. Depen
dent Student’s Information
Student’s Last Name Student’s First Name Student’s M.I. Student’s IRSC ID Number
Student’s Street Address (include apt. no.) Student’s Date of Birth
City State Zip Code Student’s Email Address
Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
B. Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2020, through
June 30, 2021, or if the other children would be required to provide parental information if they were completing a
FAFSA for 2020-2021. Include children who meet either of these standards, even if they do not live with your parent(s).
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue to provide more than half of their support through June 30, 2021.
Include the name of the college for any household member,
excluding your parent(s), who will be enrolled, at least half
time in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2020,
and June 30, 2021. If more space is needed, attach a separate page with the student’s name and IRSC ID at the top.
Fu
ll Name
Example Missy Jones
Age
Example
18
Relationship
Example Sister
College
Example Central University
Will be Enrolled at
Least Half Time
Example Yes or No
C. Dependent Student’s Income Information to Be Verified
1. TAX RETURN FILERS—Important Note: If the stu
dent filed, or will file, an amended 2018 IRS tax return, the student must
contact the financial aid office before completing this section.
Instructions: Complete this section if the student, filed or will file a 2018 income tax return with the IRS. The best way to
verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the student has not already used the
tool, go to FAFSA.gov, log in to the student’s FAFSA record, select “Make FAFSA Corrections,and navigate to the
Financial Information section of the form. From there, follow the instructions to determine if the student is eligible to use the
IRS Data Retrieval Tool to transfer 2018 IRS income tax information into the student’s FAFSA. It takes up to two weeks for
IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight
weeks for paper IRS tax return filers.
Student’s Name: IRSC ID:
Check the box that applies:
The student has used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2018 IRS income
information into the student’s FAFSA.
The student has not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to retrieve and
transfer 2018 IRS income information into the student’s FAFSA once the student has filed a 2018 IRS tax return. See
instructions above for information on how to use the IRS Data Retrieval Tool. The student’s school cannot complete the
verification process until the IRS information has been transferred into the FAFSA.
The student is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and the student will submit
to the school a 2018 IRS tax return transcript—not a photocopy of the income tax return. To obtain an IRS tax return
transcript, go to www.IRS.gov and click on the “Get Transcript of Your Tax Records” link, select “ONLINE” or “MAIL”.
Make sure to request the “IRS Tax Return transcript” and not the “IRS Tax Account transcript.” You will need your
Social Security Number, date of birth, and the address on file with the IRS. (Typically this will be the address used when
the 2018 IRS tax return was filed.) It takes up to two weeks for IRS income information to be available for electronic IRS
tax return filers, and up to eight weeks for paper IRS tax return filers.
Check here if the student’s IRS tax return transcript is attached to this worksheet.
Check here if the student’s IRS tax return transcript will be submitted to the student’s school later. Verification
cannot be completed until the IRS tax return transcript has been submitted to the student’s school.
2.
TAX RETURN NONFILERS—Complete this section if the student, will not file and is not required to file a 2018 income tax
return with the IRS.
Check
the box that applies:
The student was not employed and had no income earned from work in 2018.
The student was employed in 2018 and has listed below the names of all the student’s employers, the amount earned
from each employer in 2018, and whether an IRS W-2 form is attached. Attach copies of all 2018 IRS W-2 forms issued
to the student by employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed,
attach a separate page with the student’s name and IRSC ID at the top.
Employer’s Name
Example Suzy’s Auto Body Shop
2018 Amount Earned
Example $2,000.00
IRS W-2 Attached?
Example Yes or No
D. Parent’s Income Information to Be VerifiedNote: If two parents were reported in Section B of this worksheet, the
instructions and certifications below refer and apply to both parents.
1. TAX RETURN FILERS—Important Note: If the student’s parent(s), filed or will file, an amended 2017 IRS tax return the
student’s financial aid office must be contacted before completing this section.
Instructions: Complete this section if the student’s parent(s) filed or will file a 2018 income tax return with the IRS. The best
way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the student’s parent(s) has
not already used the tool, the parent and the student should go to FAFSA.gov, log in to the student’s FAFSA record, select
“Make FAFSA Corrections,and navigate to the Financial Information section of the form. From there, follow the instructions
to determine if the parent(s) is eligible to use the IRS Data Retrieval Tool to transfer 2018 IRS income tax information into the
student’s FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval Tool for
electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If you need more information about
whether or how to use the IRS Data Retrieval Tool see the student’s financial aid office.
Check the box that applies:
The stu
dent’s parent has used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2018 IRS income
information into the student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. The
student’s school will use the IRS information transferred into the student’s FAFSA to complete the verification process.
Student’s Name: IRSC ID:
The student’s parent has not yet used th
e IRS Data Retrieval Tool, but will use the tool to transfer 2018 IRS income
information into the student’s FAFSA once the parent’s IRS tax return has been filed (THIS IS THE BEST OPTION IF
YOU HAVE NOT ALREADY USED THE DATA RETRIEVAL TOOL). See instructions above for information on
how to use the IRS Data Retrieval Tool. The student’s financial aid office cannot complete verification until the parent has
transferred IRS information into the student’s FAFSA.
The parent is unable or chooses not to use the IRS Data Retrieval Tool, and the parent will submit to the student’s school a
copy of the parent’s 2018 IRS tax return transcript(s)—not photocopies of the income tax return. To obtain an IRS tax
return transcript, go to www.IRS.gov and click on the “Get Transcript of Your Tax Record” link, select “ONLINE” or
“MAIL”. Make sure to request the “IRS Tax Return transcript” and not the “IRS Tax Account transcript.” You will
need your Social Security Number, date of birth, and the address on file with the IRS. (Typically this will be the address
used when the 2018 IRS tax return was filed). It takes up to two weeks for IRS income information to be available for
electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If the parents are married, and
separate 2018 tax returns were filed, 2018 IRS tax return transcripts must be submitted for each parent.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to the student’s school later. Verification cannot be
completed until the IRS tax return transcript(s) has been submitted to the school.
2
. TAX RETURN NONFILERS—Co
mplete this section if the student’s parent(s) will not file and is not required to file a 201
7
in
come tax return with the IR
S.
Check
the box that applies:
The parent(s) was not employed and had no income earned from work in 2018.
The parent(s) was employed in 2018 and has listed below the names of all the parent’s employers, the amount earned
from each employer in 2018, and whether an IRS W-2 form is attached. Attach copies of all 2018 IRS W-2 forms issued
to the parent(s) by employer(s). List every employer even if they did not issue an IRS W-2 form. If more space is needed,
attach a separate page with the student’s name and IRSC ID at the top.
Employer’s Name
Example Suzy’s Auto Body Shop
2018 Amount Earned
Example $2,000.00
IRS W-2 Attached?
Example Yes or No
E. Parent’s Other Information to Be Verifie
d
1. Com
plete this section if someone in the student’s parent’s household (listed in Section B) received benefits from
the
Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2016 or 2017
calendar years. YOU MAY BE REQUIRED TO PROVIDE DOCUMENTATION OF SNAP BENEFITS RECEIVED.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2017 or 2018. If asked by the
student’s school, I will provide documentation of the receipt of SNAP benefits during 2017 and/or 2018.
T
otal amount received:
Name of person receiving benefits:
2.
Complete this section if one of the student’s parents paid child support in 2018.
One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2018. The parent has
indicated below the name of the person who paid the child support, the name of the person to whom the child support was
paid, the names of the children for whom child support was paid, and the total annual amount of child support that was
paid in 2018 for each child. YOU MAY BE REQUIRED TO PROVIDE DOCUMENTATION OF CHILD
UPPORT PAID. If you need more space, attach a separate page that includes the student’s name and IRSC ID at the
top.
Student’s Name: IRSC ID:
Name of Person Who Paid
Child Support
Example (Marty Jones)
Name of Person to Whom Child
Support was Paid
Example (Chris Smith)
Name of Child for Whom
Support Was Paid
Example (Terry Jones)
Amount of Child
Support Paid in 2018
Example ($6,000)
F. Identity and Statement of Educational P
urpose (To Be Signed at the Institution)
The student must appear in person at Indian River State College to verify his or her identity by presenting a valid
government-issued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or
passport. The IRSC employee will make a copy of the student’s photo ID that is annotated with the date it was
received and the name of the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of an IRSC employee, the following:
Statement of Educational Purpose
I certify that I, (Print Student’s Name)
am the individual signing this Statement of Educational Purpose and that the federal student financial
assistance I may receive will only be used for educational purposes and to pay the cost of attending
Indian River State College for 2020-2021.
Student’s Sig
nature Date
NOTARIZED STATEMENT IS ONLY NECESSARY IF STUDENT CANNOT APPEAR IN PERSON
(copy of Driver’s License, US Passport, or other picture ID must accompany this form if signed by a notary)
Notary’s Certificate of Acknowledgement
State of
City/County of
On (Date) ,
before me, (Notary’s name) ,
personally appeared, (Printed name of signer) ,
and provided to me on basis of satisfactory evidence of identification
(Type of government-issued photo ID provided)
to be the above-named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal) (Notary signature)
My commission expires on
(date)
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Student’s Name: IRSC ID:
WARNING: If you purposely give false or
misleading information on this worksheet,
you may be fined, be sentenced to jail, or
both.
G. Certification and Signatures
Each person signing this worksheet certifies that all of
the information reported on it is complete and correct.
The student and one parent must sign and date.
Student’s Signature Date
Parent’s Signature Date
Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the financial aid office at your school.
You should make a copy of this worksheet for your records.
I
RSC is an EA/EO educational institution.
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