DEPENDENT OTHER UNTAXED INCOME VERIFICATION WORKSHEET (V6)

Transcription

1 Student Financial Aid Office 1003 Monroe Avenue Memphis, TN Office: (901) Fax: (901) DEPENDENT OTHER UNTAXED INCOME VERIFICATION WORKSHEET (V6) INSTRUCTIONS: Your Free Application for Federal Student Aid (FAFSA) was selected for a review process called verification. Verification must be completed before your financial aid package can be determined. Verification requires the Financial Aid Office to confirm the information you reported on your FAFSA. To verify that you provided correct information, we will compare your FAFSA with the information provided on this worksheet along with any other required documents. If there are differences, we will update your FAFSA, recalculate your aid eligibility, and determine a financial aid package. Please complete ALL sections of this worksheet, attach all requested documentation, and sign and return to the Student Financial Aid Office. Verification cannot be completed until all requested documents are received and reviewed. For Tax Filers - The Student Financial Aid Office highly RECOMMENDS use of the IRS Data Retrieval Tool (DRT) that is part of the FAFSA on the Web as this is the best way to verify income, and in most cases, no further documentation is needed to verify 2015 IRS income tax return information that was transferred into the FAFSA and not changed. A paper copy of your federal 1040 tax form is no longer acceptable documentation. To Use the IRS Data Retrieval Tool: Log into your FAFSA online at Select Make FAFSA Corrections, and navigate to the Financial Information section of the form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2015 IRS income tax information into your FAFSA. It takes up to three 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 when, or how to use the IRS Data Retrieval Tool see your financial aid administrator. If it has been at least 3 weeks since you electronically filed your tax return, and you cannot use the IRS data retrieval tool, please obtain a free federal tax transcript by going to the IRS website Under the Tools menu, click on Get a Tax Transcript. Select the option labeled Get Transcript by MAIL. Once your transcript request is validated, the IRS will mail the transcript within 5 to 10 calendar days to the address on file for you. A. STUDENT INFORMATION Student Name: Student ID#: SSN: Date of Birth: Permanent Address: City/State/Zip: Phone: B. HOUSEHOLD INFORMATION List in the chart at the top of page 2 the people in your parent(s) household. Include: Yourself, even if you don t live with your parent(s); Your parent(s), (including stepparent) even if you don t live with your parent(s); Your parent(s) other dependent children if your parent(s) will provide more than half of their support from July 1, 2016, through June 30, 2017, even if the children do not live with them; Other people, if they now live with your parent(s) and they will provide more than half of their support and will continue to provide more than half of their support through June 30, V6 Dependent Page 1 of 6

2 Full Name Age Relationship to Student College Martha Jones (example) 21 Self Baptist College For any household member who will be enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2016, and June 30, 2017, include the name of the college. same information for each additional household member. Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institutions is inaccurate. C. STUDENT TAX INCOME INFORMATION Did you file a Federal Income Tax Return for 2015? (Circle one) Yes No 1. If you answered YES, check the box that applies: (SEE INSTRUCTION BOX ON PAGE 1 FOR DETAILS) RECOMMENDED I have used the IRS Data Retrieval Tool to transfer my 2015 IRS income information into my FAFSA. I have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my 2015 IRS income information into my FAFSA. I am unable or choose not to use the IRS Data Retrieval Tool, and I will submit my 2015 IRS tax return transcript(s) not photocopies of my income tax return to the Student Financial Aid Office. Check here if a 2015 IRS Tax Return Transcript is attached. Check here if a 2015 IRS Tax Return Transcript(s) will be provided later. NOTE: If you filed separate 2015 IRS income tax returns, a 2015 IRS Tax Return Transcript must be provided for both the student and spouse. 2. If you answered NO, check the box that applies: I WAS NOT employed and had NO income earned from work in I was employed in 2015 and have listed below the names of all employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is provided. You must provide copies of all 2015 IRS W- 2 forms issued by your employers. NOTE: List every employer even if the employer did not issue an IRS W-2 form. same information for each additional employer. Employer s Name 2015 Amount IRS W-2 Provided? Earned Suzy s Auto Body Shop (example) $2, Yes V6 Dependent Page 2 of 6

3 D. PARENT(S) TAX INCOME INFORMATION Student ID # Did your parent(s) file a Federal Income Tax Return for 2015? (Circle one) Yes No 1. If the parent(s) answered YES, check the box(s) that applies: (SEE INSTRUCTION BOX ON PAGE 1 FOR DETAILS) RECOMMENDED My parent(s) has/have used the IRS Data Retrieval Tool to transfer their 2015 IRS income information into the FAFSA. My parent(s) has/have not yet used the IRS Data Retrieval Tool, but will use the tool to transfer their 2015 IRS income information into my FAFSA. My parent(s) was/were unable or chose not to use the IRS Data Retrieval Tool, and will submit their 2015 IRS tax return transcript(s) not photocopies of their income tax return to the Student Financial Aid Office. Check here if a 2015 IRS Tax Return Transcript is attached. Check here if a 2015 IRS Tax Return Transcript(s) will be provided later. NOTE: If your parent(s) filed separate 2015 IRS income tax returns, a 2015 IRS Tax Return Transcript must be provided for both parents. 3. If the parent(s) answered NO, check the box that applies: My parent(s) WAS/WERE NOT employed and had NO income earned from work in My parent(s) WAS/WERE employed in 2015 and have listed below the names of all employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is provided. The parent(s) must provide copies of all 2015 IRS W-2 forms issued by their employers. NOTE: List every employer even if the employer did not issue an IRS W-2 form. same information for each additional employer. Employer s Name 2015 Amount IRS W-2 Provided? Earned Suzy s Auto Body Shop (example) $2, Yes E. RECEIPT OF SNAP (Supplemental Nutrition Assistance Program) BENEFITS SNAP (formerly known as the Food Stamp Program): Did the parent(s) or anyone included in their household receive SNAP benefits in 2014 or 2015? (Circle One) YES NO Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may require documentation from the agency that issued the SNAP benefits in 2014 or F. CHILD SUPPORT PAID Did your parent(s) pay child support in 2015: (Circle One) YES NO If YES, list below the names of the persons who paid the child support, the names of the persons to whom the child support was paid, the names of the children for whom the child support was paid, and the total annual amount of child support that was paid in 2015 for each child. same information for each additional child. V6 Dependent Page 3 of 6

4 Name of Person Who Paid Child Support Name of Person to Whom Child Support was Paid Name of Child for Whom Support Was Paid Amount of Child Support Paid in 2015 Note: If we have reason to believe that the information regarding child support paid is not accurate, we may require additional documentation, such as, a copy of the separation agreement or divorce decree that shows the amount of child support to be provided; a statement from the individual receiving the child support certifying the amount of child support received; or copies of the child support payment checks or money order receipts. G. OTHER UNTAXED INCOME Complete each section below as it applies to both the student and the parent(s) whose information is reported on the FAFSA. If any item does not apply, enter N/A for Not Applicable where a response is requested, or enter 0 in an area where an amount is requested. To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in 2015, multiply that amount by the number of months in 2015 you paid or received it. If you did not pay or receive the same amount each month in 2015, add together the amounts you paid or received each month. If more space is needed, provide a separate page with the student s name and Student ID number at the top. A. Payments to tax-deferred pension and retirement savings - List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S. Name of Person Who Made the Payment Total Amount Paid in 2015 B. Child support received - List the actual amount of any child support received in 2015 for the children in your household. Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid. Name of Person Who Received Child Support Name of Child for Whom Support Was Received Amount of Child Support Paid in 2015 C. Housing, food, and other living allowances paid to members of the military, clergy, and others - Include cash payments and/or the cash value of benefits received. Do not include the value of on-base military housing or the value of a basic military allowance for housing. Name of Recipient Type of Benefit Received Amount of Benefit Received in 2015 V6 Dependent Page 4 of 6

5 D. Veteran s non-education benefits - List the total amount of veterans non-education benefits received in Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC), and/or VA Educational Work- Study allowances. Do not include federal veteran s educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill Name of Recipient Type of Veterans Non-Education Benefit Amount of Benefit Received in 2015 E. Other untaxed income - List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc. Do not include any items reported or excluded in A D above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels. Name of Recipient Type of Other Untaxed Income Amount of Other Untaxed Income Received in 2015 F. Money received or paid on the student s behalf - List any money received or paid on the student s behalf (e.g., payment of student s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received in Include support from a parent whose information was not reported on the student s FAFSA, but do not include support from a parent whose information was reported. For example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person's contributions unless the person is the student s parent whose information is reported on the student s FAFSA. Amounts paid on the student s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student s parents, such as grandparents, aunts, and uncles of the student. Purpose: e.g., Cash, Rent, Books Amount Received in 2015 Source V6 Dependent Page 5 of 6

6 G. Additional information: - So that we can fully understand the student s family's financial situation, please provide below any information about any other resources, benefits, and other amounts received by the student and any members of the student s household. This may include items that were not required to be reported on the FAFSA or other forms submitted to the financial aid office, and include such things as federal veteran s education benefits, military housing, SNAP, TANF, etc. If more space is needed, provide a separate page with the student s name and Student ID number at the top. Name of Recipient Type of Financial Support Amount of Financial Support Received in 2015 Comments: H. CERTIFICATION AND SIGNATURE Each person signing below certifies that all of the information reported is complete and correct. Student s Name (Print) WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or both. Student s Signature (Required) Parent Signature (Required) Date (Required) Date (Required) V6 Dependent Page 6 of 6