STUDENT INFORMATION SECTION 1 SECTION 2

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2 STUDENT INFORMATION If you filed a Federal Tax Return with the IRS, complete SECTION 1 If you filed and amended your taxes, complete SECTION 2 If you did not file taxes and were NOT required to file taxes, complete SECTION 3 SECTION 1 Check the appropriate box and submit a W2 You successfully transferred your 2014 IRS Federal Tax information onto your FAFSA via the online IRS Data Retrieval Tool. If you successfully transferred your 2014 IRS income information, you do not need to attach an IRS Tax Return Transcript to this worksheet. However, your IRS Data Retrieval must be successfully processed by the Federal Student Aid Processor BEFORE submitting this worksheet without a tax return transcript. Your FAFSA transaction on file with the Financial Aid Office must also confirm that you successfully transferred IRS Income Information before we can accept this Verification Worksheet without an IRS Tax Return Transcript. You were unable (OR) chose not to transfer your 2014 IRS Tax Information via the IRS Data Retrieval Tool. As a result, you are required to attach a paper 2014 IRS Tax Return Transcript with this Federal Verification Worksheet. If this Federal Verification Worksheet is submitted to the Financial Aid Office without your paper IRS Tax Return Transcript, your file will be considered incomplete. To obtain a 2014 IRS Tax Return Transcript, go to and click on the Order a Return or Account Transcript link. Make sure to request the IRS Tax Return Transcript and not the IRS Tax Account Transcript. In most cases, for electronic filers, a 2014 IRS Tax Return Transcript may be requested from the IRS within 2 3 weeks after the 2014 IRS income tax return has been accepted by the IRS. Generally, for filers of 2014 paper IRS income tax returns, the 2014 IRS Tax Return Transcript may be requested within 8 11 weeks after the 2014 paper IRS income tax return has been received by the IRS. Check here to confirm that your 2014 IRS Tax Return Transcript is attached. If this Federal Verification Worksheet is submitted to the Financial Aid Office without your paper IRS Tax Return Transcript, your file will be considered incomplete. SECTION 2 Check the appropriate box and submit a W2 You filed and amended your 2014 Federal Income Tax return originally filed with the IRS. As a result, you must attach a 2014 IRS Tax Return Transcript; and a signed copy of the 2014 IRS Form 1040X, Amended U.S. Individual Income Tax Return, filed with the IRS. If this Federal Verification Worksheet is submitted to the Financial Aid Office without your IRS Tax Return Transcript and IRS Form 1040X, your file will be considered incomplete. To obtain a 2014 IRS Tax Return Transcript, go to and click on the Order a Return or Account Transcript link. Make sure to request the IRS Tax Return Transcript and not the IRS Tax Account Transcript. In most cases, for electronic filers, a 2014 IRS Tax Return Transcript may be requested from the IRS within 2 3 weeks after the 2014 IRS income tax return has been accepted by the IRS. Generally, for filers of 2014 paper IRS income tax returns, the 2014 IRS Tax Return Transcript may be requested within 8 11 weeks after the 2014 paper IRS income tax return has been received by the IRS. Check here to confirm that a 2014 IRS Tax Return Transcript is provided. Check here to confirm that a 2014 IRS Form 1040X is provided Page 2 of 9 (V6 Dependent)

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5 A copy of the separation agreement or divorce decree that shows the amount of child support to be provided; A signed statement from the individual receiving the child support certifying the amount of child support received; or Copies of the child support payment checks, money order receipts, or similar records of electronic payments having been made. Complete this ONLY if you reported on your FAFSA that someone in your parent/guardian s household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as foods stamps) during the 2013 or 2014 calendar years. If your parent did not report this information on your FAFSA, you are not required to complete this section. Yes, SNAP benefits were received in 2013 and/or Please attach a copy of the Statement of Notice as verification of the benefits received (please do not submit a copy of the EBT card). Student/Benefit Recipient Information: The following is to be completed by the student and/or person in the household who received SNAP benefits. Name of person who received benefits: Case Number: Relationship to Student (Self, Spouse, Parent): Indicate the year the benefits received: Year Year Household Resources Information Verification of Other Untaxed Income for 2014 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. If you, the student was required to provide parental information on the FAFSA answer each question below as it applies to you and the parent(s) whose information is on the FAFSA. If you, the student was not required to provide parental information on the FAFSA, answer each question below as it applies to you the student. To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in 2014, multiply that amount by the number of months in 2014 you paid or received it. If you did not pay or receive the same amount each month in 2014, add together the amounts you paid or received each month. Page 5 of 9 (V6 Dependent)

6 If more space is needed, provide a separate page with the student s name and 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 2014 B. Child support received List the actual amount of any child support received in 2014 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 Adult Who Received the Support Name of Child For Whom Support Was Received Amount of Child Support Received in 2014 Verification of Other Untaxed Income for 2014 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 2014 D. Veterans 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 veterans educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill Page 6 of 9 (V6 Dependent)

7 Name of Recipient Type of Veterans Non-education Benefit Amount of Benefit Received in 2014 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 2014 Verification of Other Untaxed Income for 2014 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 2014 Source Page 7 of 9 (V6 Dependent)

8 Verification of Other Untaxed Income for 2014 Additional information: So that we can fully understand the student s family's financial situation, please provide below 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 veterans education benefits, military housing, SNAP, TANF, etc. If more space is needed, provide a separate page with the student s name and ID number at the top. Name of Recipient Type of Financial Support Amount of Financial Support Received in 2014 Comments: Page 8 of 9 (V6 Dependent)

9 Sign and Date By signing this worksheet, we certify that all the information reported on this worksheet is complete and correct. The student and one parent must sign and date. WARNING: If you purposely give false or misleading information on this verification worksheet, you may be fined, sentenced to jail, or both. Student Date Parent Date Student Telephone: Best time to call VERIFICATION WORKSHEET CHECKLIST Is the Verification Worksheet completely filled out and signed by the student and parent? If you were unable to OR chose not to use the IRS Data Retrieval Tool, did you attach a copy of your and your parent(s) 2014 Federal Federal Tax Return Transcript and/or Account Transcript? If you do not have a copy of your and your parents 2014 Federal Tax Return Transcript and/or Account Transcript, DO NOT submit this worksheet. Your file will not be processed. If you transferred your IRS Federal Tax Information, does your current FAFSA transaction confirm that your IRS Data Retrieval was processed by the Central Processor successfully? If not, do not submit this worksheet. Your file will not be processed. Please attach W2 for everyone that worked in PLEASE NOTE Incomplete Verification Worksheets will NOT be processed by your Financial Aid Counselor, regardless of circumstance. To ensure timely processing of your documents, we strongly encourage you to submit all documents by the priority deadline listed on the Financial Aid Website. If your documents are complete, please allow 2-3 weeks for processing from the date when you submitted your documents. Documents can be faxed, mailed, or submitted in person to the Financial Aid Office. If you fax your documents, please allow 48 hours to confirm receipt of documents with the Financial Aid Office. Documents received will be removed from your To Do List on CMS. Your Financial Aid Counselor will contact you via your CSUMB if additional follow up is needed from you. Please follow up with all requests in a timely manner. Page 9 of 9 (V6 Dependent)