– Verification Worksheet
Independent Student





Your – 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 reported on your FAFSA. To verify that you provided correct information, the financial aid administrator 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 must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as possible so that your financial aid will not be delayed.

  Student Family Income SNAP Child Support
A. INDEPENDENT STUDENT'S INFORMATION











INDEPENDENT STUDENT'S FAMILY INFORMATION

List below the people in the student's household. Include:
•The student. •The student's spouse, if the student is married. •The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, , through June 30, , even if the children do not live with the student. •Other people if they now live with the student and the student or spouse provides more than half of the other people’s support and will continue to provide more than half of their support through June 30, .
Please include below information about any household member 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, , and June 30, .





Yes     No


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.
INDEPENDENT STUDENT'S INCOME INFORMATION TO BE VERIFIED
TAX RETURN FILER - Complete this section if the student and spouse filed or will file a  income tax return with the IRS.
TAX RETURN NON-FILER - Complete this section if the student and spouse will not file and are not required to file a  income tax return with the IRS.

Important Note: The instructions below apply to the student and spouse, if the student is married. Notify the financial aid office if the student or spouse filed separate IRS income tax returns for  or had a change in marital status after the end of the  tax year on December 31, .

Instructions: Complete this section if the student and spouse filed or will file a   IRS income tax return(s). The best way to verify income is by using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify  income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed.

The student has used the IRS DRT in FAFSA on the Web to transfer  IRS income tax return information into the student’s FAFSA.

The student has not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer  IRS income tax return information into the student’s FAFSA once the  IRS income tax return has been filed.

The student is unable or chooses not to use the IRS DRT in FAFSA on the Web, and instead will provide the school a  IRS Tax Return Transcript(s).

A  IRS Tax Return Transcript may be obtained through the: In most cases, for electronic tax return filers,  IRS income tax return information for the IRS DRT is available within 2–3 weeks after the  electronic IRS income tax return has been accepted by the IRS. Generally, for filers of  paper IRS income tax returns, the  IRS income tax return information is available for the IRS DRT within 8–11 weeks after the  paper IRS income tax return has been received by the IRS. Contact the financial aid office if more information is needed about using the IRS DRT or obtaining an IRS Tax Return Transcript.

If the student and spouse filed separate  IRS income tax returns,  IRS Tax Return Transcripts must be provided for both.

The student and spouse were not employed and had no income earned from work in .
The student and/or spouse were employed in  and have listed below the names of all employers, the amount earned from each employer in , and whether an IRS W-2 form is provided. Provide copies of all  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.




Yes     No


Note: We may require you to provide documentation from the IRS that indicates a  IRS income tax return was not filed with the IRS.
STUDENT'S OTHER UNTAXED INCOME
To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in  , multiply that amount by the number of months in   you paid or received it. If you did not pay or receive the same amount each month in  , add together the amounts you paid or received each month.

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.

The student did not make any payments to tax-deferred pension and retirement savings plans in  .

The student made payments to tax-deferred pension and retirement savings plans in  .

 



B. Child Support Received
List the actual amount of any child support received in  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.

The student did not receive any child support in .

The student received child support in .

 




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.

The student did not receive living allowances in  .

The student received living allowances in  .

 




D. Veterans Noneducation Benefits
List the total amount of veterans noneducation 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.

The student did not receive Veterans Noneducation benefits in  .

The student received Veterans Noneducation benefits in  .

 




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.

The student did not receive other untaxed income in  .

The student received other untaxed income in  .

 




F. Money Received or Paid on 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.

The student did not receive any additional money on their behalf in  .

The student received additional money on their behalf in  .

 




Additional Information:
Please provide 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.

 





INDEPENDENT STUDENT'S SNAP

Verify if anyone in the student’s household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the or  calendar years.

The student's household includes:
•The student. •The student's spouse, if the student is married. •The student's or spouse's children, if you will provide more than half of their support from July 1, , through June 30, , even if the children do not live with the student. •Other people if they now live with the student and the student provide more than half of the other people's support and will continue to provide more than half of their support through June 30, .

No member of the student's household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as the Food Stamp Program) sometime during  or . A member of the student's household received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as the Food Stamp Program) sometime during  or .

SNAP may be known by another name in some states. For assistance in determining the name used in a state, please call 1-800-4FED-AID (1-800-433-3243).

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  or . .
INDEPENDENT STUDENT'S CHILD SUPPORT

Complete this section if you, the student (and, if married, your spouse) paid child support in .

The student or spouse, who is a member of the student's household, did not pay child support in . The student or spouse, who is a member of the student's household, paid child support in .


Provide in the space below the names of the persons who paid the child support, the names and ages 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  for each child.







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 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.

WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

By signing this Verification Worksheet, I certify that all of the information reported is complete and correct.

Student SignatureDate

By submitting this electronic form, I certify that all of the information reported is complete and correct.