Household Resources Worksheet (F17HHD) Dependent

Transcription

1 Household Resources Worksheet (F17HHD) Dependent Office of Student Financial Aid One University Blvd 327 Millennium Student Center St. Louis MO T: F: Follow us on Your FAFSA was selected by the U.S. Department of Education for review in a process called Verification. In this process, UMSL is required to compare information from your FAFSA with the information on this worksheet and with any other required documents. The law says we have the right to ask you for information before you are awarded any financial aid and must review the requested information under the financial aid program rules (34 CFR, Part 668). Verification must be completed before your financial aid can be awarded and before any aid will be credited to your student account. 1. Fully complete and sign this worksheet with you parent(s) listed on your FAFSA. You may visit our website at for more information about the Verification Process. 2. If information on this worksheet is different than information on your FAFSA, you may be required to submit additional documents for clarification. If corrections to your FAFSA information are necessary, UMSL will electronically send those corrections to the federal processor who will send you an Information Acknowledgment Student Aid Report for your records. Student Information Last Name First Name M.I. UMSL Student ID Date of Birth Phone Number (include area code) Family Information DEPENDENT: In general you are considered a dependent student if one or more of the following apply to you; you are under 24 years old, not married, are not a graduate student, and/or do not have children. 1. List yourself below: Full Name Age College Name 2. List your parent(s) below, including a stepparent in the household. If your parents are separated or divorced, only list the parent/stepparent whose information was provided on the FAFSA. Full Name Age Relationship to Student UMSL Read Carefully and List Below Any 3. Other children if your parents will provide more than half of their financial support between July 1, 2016, and June 30, 2017, or would be required to give parental information when applying for Title IV Federal student aid, even if they are not living with the parent. 4. Other people if they now live with you and your parents provide more than half their financial support and will continue to provide more than half of their financial support between July 1, 2016, and June 30, Do not include foster children. Full Name Age Relationship to Student College Name Will be Enrolled at Least Half Time If necessary, attach a separate sheet of paper with additional household members Financial Information If you did not or cannot use the IRS Data Retrieval Tool, you must attach a copy of all 2015 federal income tax return or federal tax return transcripts for all filers whose information is reported on the FAFSA. If you filed an Amended Tax Return, you must submit a signed form 1040X in addition to either your signed Tax Return (1040, 1040A, 1040EZ) or tax return transcript. Instructions on how to request a tax return transcript can be found on the last page of this form. You must submit any and all W-2 s even if you used the IRS Data Retrieval Tool or are submitting your tax return/transcript.

2 Name Student Number Check only one box below regarding STUDENT INFORMATION Check here if you used the IRS Data Retrieval Tool and you have attached all W-2 s. Check here if you are attaching a copy of your signed tax return or tax return transcript and you have attached all W-2 s. Check here if you will not file and are not required to file a 2015 federal tax return. Please complete Employer Income Section below and attach any W-2(s). Write zero s in the box if you had no income. Check only one box below regarding PARENT INFORMATION Check here if your parent(s) used the IRS Data Retrieval Tool and you have attached all W-2 s. Check here if you are attaching a copy of your parent s tax return or tax return transcript and you have attached all W-2 s. If your parents are married and filed separately, you must submit copies of both tax returns or tax return transcripts. If a step-parent is in the household and filed separately, then both parent and step-parent tax returns/transcripts are required. Check here if your parent(s) will not file and are not required to file a 2015 federal tax return. Please complete Employer Income Section below and attach any W-2(s). Write zero s in the box if your parent(s) had no income. If your parents are married and only one filed taxes, a non-filing statement from the other parent is required and must be signed by that parent. Please include the student s name and ID number on the statement. The statement should also say that the person did not file and was not required to file a 2015 federal income tax return Employer Income If you DID NOT and ARE NOT required to file a 2015 federal income tax return, please submit all 2015 W-2s. If you did not receive a W-2 but did earn income, please list the income amount(s) and sources(s) below (additional documentation may be required). Enter information for 2015, using annual, not monthly amounts below. If you are unsure about whether or not your income level exceeds federal income filing thresholds, consult IRS Publication 17 at Employer/Source of Income Student Amount Parent(s) Amount If necessary, attach a separate sheet of paper with additional income. Please fill out the following information using yearly amounts. Provide the information below for the student and the parent(s) listed on the FAFSA. If an item does not apply, please enter N/A or 0 A. Payments to tax-deferred pension and retirement savings. List any payments (direct or withheld from earnings) to taxdeferred 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 Adult Who Received the Support Name of Child For Whom Support Was Received Amount of Child Support 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. Type of Benefit Received Amount of Benefit

3 Name Student Number 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 veteran s educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post- 9/11 GI Bill. Type of Veterans Non-education Benefit Amount of Benefit 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 extended foster care benefits, student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Innovation and Opportunity Act (WIOA) educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels. Type of Other Untaxed Income Amount of Other Untaxed Income 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 already 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 Source Amount G. Additional Information. So that we can fully understand the financial situation of the student s family, 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 veteran s education benefits, military housing, TANF, etc. Type of Financial Support Amount of Financial Support H. SNAP Benefits The parents certify that, a member of the parents household, received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as the Food Stamp Program) sometime during 2014 or SNAP may be known by another name in some states. For assistance in determining the name used in a state, please call FED-AID ( ). No members of the household received SNAP benefits.

4 Name Student Number WRITE NAME OF PERSON RECEIVING ON LINE 2015 Budget/Resources The 2015 income reported for you and your parent(s) appears insufficient to support the number of people in your household. Please complete this form to clarify how you and your parent(s) were able to support a family during Fill out the chart below using your household s 2015 annual income and expenses. *** DO NOT LEAVE ANY BLANKS ENTER 0 OR N/A *** Annual Income 2015 Amount Annual Expenses 2015 Amount Parent Income Housing (please circle) Rent Own Student Income Utilities (electricity, water, etc) Savings Transportation Credit Card/Loans Food Child Support received Medical Social Security income Entertainment SNAP (Food Stamps): SSI/TANF/Welfare: Disability: Unemployment: Family/Friend Support: Communication (phone, internet, etc.) Debt Payments School Expenses Clothing: 2015 Total Income 2015 Total Expenses Briefly explain how you are able to support the number of people in your household with the resources listed above (attach another piece of paper if necessary): Signatures For the PELL Grant program only, verification materials must be submitted no later than 90 days after the last day you attend, or August 31, 2017, whichever is earlier. For all other programs, verification materials must be submitted no later than two weeks prior to the last date of half-time attendance. No aid will be processed for paperwork received after these deadlines. Each person signing below certifies that all of the information reported to qualify for federal student aid is complete and correct. As a dependent, the student and one parent whose information was reported on the FAFSA must sign and date. Your Signature (Student) Date Parent Signature Date WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.

5 How to Request a Tax Return Transcript or Wage and Income Transcript from the IRS Requesting a Tax Return Transcript to be Mailed: 1. Visit Under the Tools section, select Get a Tax Transcript 2. Choose Get Transcript by Mail 3. Enter your information and the address listed on your taxes, then click Continue 4. Select Return Transcript from the Type of Transcript drop-down menu and then select the 2015 tax year. 5. Click Continue 6. You will receive a copy within 5-10 calendar days. Requesting a Tax Return Transcript by Phone: 1. Call the IRS at (7:00am-7:00pm) 2. Follow prompts for the language of choice, Press 2 for Answers about personal income taxes 3. Press 1 for Questions about a form you already submitted 4. Press 2 for Tax Return Transcript 5. Enter the SSN, Address and follow the prompts including the year for Continue with the prompts until you have successfully requested the transcript 7. You will receive a copy within 5-10 calendar days. Requesting a Tax Return Transcript or a Wage and Income Transcript as a PDF: (see #5 for items needed to create an account w/the IRS) 1. Visit Under the Tools section, select Get a Tax Transcript 2. Choose Get Transcript Online 3. Select Get Started unless you re a returning user to the IRS website 4. Follow the steps on the screen 5. You will need the following information to create the account a. Full name b. c. Birthdate d. Social Security Number (SSN) or Individual Tax Identification Number (ITIN) e. Tax Filing Status f. Current Address 6. Enter the Security code when prompted 7. Select Higher Education/Student Aid for the reason you need a transcript 8. Select Return Transcript or Wage & Income Transcript and then select the 2015 tax year. 9. You should then be able to print a PDF version of the Tax Return Transcript and even save it to your computer.