V6 Verification Form Dependent Student 2016 2017 Your 2016 2017 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 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 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 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. A. Dependent Student s Information Student s Last Name Student s First Name Student s M.I. Student's PBSC 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, 2016, through June 30, 2017, or if the other children would be required to provide parental information if they were completing a FAFSA for 2016 2017. 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, 2017. 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, 2016, and June 30, 2017. If more space is needed, attach a separate page with the student s name and student s PBSC ID Number at the top. Full Name Age Relationship College Will be Enrolled at Least Half Time Missy Jones (example) 18 Sister Central College Yes Self Palm Beach State College
Student s Name: PBSC ID: C. Dependent Student s Income Information to be verified 1.TAX RETURN FILERS Important Note: See page 5 of this document if the student is a victim of identity theft or if the student has filed or will file an extension to file a 2015 tax return, an amended 2015 tax return, or a 2015 foreign tax return. Instructions: Complete this section if the student, filed or will file a 2015 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 2015 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 when or how to use the IRS Data Retrieval Tool, see your financial aid administrator. The student has used or will use the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2015 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 that was transferred in the verification process. The student is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and the student must submit to the school a 2015 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 under tools Get a Transcript link, or call 1-800-908-9946. 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 (normally this will be the address used when the 2015 IRS tax return was filed). IRS Local Office: Address: 1700 Palm Beach Lakes Blvd., WPB, FL 33401; Transcript by Fax: 1 (800) 908-9946; to make an appointment: 1 (844) 545-5640 Check here if the student s IRS tax return transcript is attached to this worksheet 2. TAX RETURN NONFILERS ONLY Complete this section if the student will not file and is not required to file a 2015 income tax return with the IRS. The student was not employed and had no income earned from work in 2015. The student was employed in 2015 and has listed below the names of all the student s employers, the amount earned from each employer in 2014, and whether an IRS W-2 form is attached. Attach copies of all 2015 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 Student s PBSC ID Number at the top. Employer s Name 2015 Amount Earned IRS W-2 Attached? Suzy s Auto Body Shop (example) $2,000.00 (example Yes (example) 2
Student s Name: PBSC ID: D. Parent s Income Information to be verified Note: 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: See page 6 of this document if the parent is a victim of identity theft or if the parent has filed or will file an extension to file a 2015 tax return, an amended 2015 tax return, or a 2015 foreign tax return. Instructions: Complete this section if the student s parent(s) filed or will file a 2015 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 2015 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 administrator. The student s parent has used or will use the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2015 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 The student is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and the student must submit to the school a 2015 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 under tools Get a Transcript link, or call 1-800-908-9946. 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 (normally this will be the address used when the 2015 IRS tax return was filed). IRS Local Office: Address: 1700 Palm Beach Lakes Blvd., WPB, FL 33401; Transcript by Fax: 1 (800) 908-9946; to make an appointment: 1 (844) 545-5640 Check here if an IRS tax return transcript(s) is attached to this worksheet 2. TAX RETURN NONFILERS ONLY Complete this section if the student s parent(s) will not file and is not required to file a 2015 income tax return with the IRS. The parent(s) was not employed and had no income earned from work in 2015 The parent(s) was employed in 2015 and has listed below the names of all the parent s employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is attached. Attach copies of all 2015 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 student s PBSC ID at the top Employer s Name 2015 Amount Earned IRS W-2 Attached? Suzy s Auto Body Shop (example) $2,000.00 (example) Yes (example) 3
Student s Name: PBSC ID: E. Student s/parent(s) Untaxed Income to Be Verified Answer each question below as it applies to you, 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 for any item, provide a separate page with the student s name and ID number at the top. 1. Payments made by student and/or parents to tax-deferred pension and retirement savings plans 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 2. Child support received List the actual amount of any child support received in 2015 for ALL children listed in the household in Section B of this worksheet. 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 2015 3. 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 by student or student s parents. 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 Received in 2015 4. Veterans non-education benefits List the total amount of veterans non-education benefits received in 2015 by the student or student s parent(s). 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 Received in 2015 4
Student s Name: PBSC ID: 5. Other untaxed income List the amount of other untaxed income received by the student or the student s parent(s) that was not reported 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 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. Type of Other Untaxed Income Amount Received in 2015 6. Money received or paid on the student s behalf List any cash support received or paid on the student s behalf (e.g., payment of student s bills) and not reported elsewhere on this form. 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. DO NOT INCLUDE SUPPORT FROM A PARENT WHOSE INFORMATION WAS ALREADY REPORTED ON THE 2016-17 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. Source of Support Purpose: e.g., Cash, Rent, Books Amount Received in 2015 7. Additional information: So that we can fully understand the family financial situation, 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 veteran s education benefits, military housing, SNAP, TANF, etc. Type of Financial Support Amount Received in 2015 5
Student s Name: F. Other Information to Be Verified PBSC ID: 1. Complete this item if one of the persons listed in Section B received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2014 or 2015 calendar years. One of the persons listed in Section B of this worksheet received SNAP benefits in 2014 or 2015. If asked by my school, I will provide documentation of the receipt of SNAP benefits during 2014 and/or 2015 2. Complete this item if one of your parents PAID child support in 2015. I/we paid child support in 2015 and have listed below the requested information for each child to whom child support was paid. If asked by the school, I/we will provide additional documentation of the payment of child support. [Do not include child support paid for children listed on your FAFSA as part of your household size or listed in Section B of this worksheet.] Name of Person who Paid Name of Person to whom Child Name of Child for whom Amount of Child Child Support Support was Paid Support was Paid & Age Support Paid in 2015 Example: Mary Smith John Smith Joseph Smith $5000 If more space is needed, attach a separate page with student s name and the last 4 digits of student s SSN at the top. Verification of 2015 IRS Income Tax Return Information for Individuals with Unusual Circumstances Individuals Who Were Victims of IRS Identity Theft A victim of IRS identity theft who has been unable to obtain a 2015 IRS Tax Return Transcript or use the IRS DRT must contact the IRS at 1-800-908-4490. You will be asked to verify your identity and then must request a copy of the Tax Return DataBase View (TRDBV) transcript. You MUST also provide the following to Financial Aid Office: A statement signed and dated by the individual indicating that he or she was a victim of IRS identity theft and that the IRS is investigating the matter. The statement must also indicate that the individual submitted a Form 14039 to the IRS, but did not keep a copy of it or that he or she was not required to file the form Individuals Granted a Filing Extension by the IRS If an individual is required to file a 2015 IRS income tax return and has been granted a filing extension by the IRS, provide the following documents: A copy of the IRS Form 4868, Application for Automatic Extension of Time to File U.S. Individual Income Tax Return, that was filed with the IRS for tax year 2015; and A copy of IRS Form W-2 for each source of employment income received for tax year 2015 and, if self-employed, a signed statement certifying the amount of the individual s AGI and the U.S. income tax paid for tax year 2015. NOTE: Persons who filed a FORM 4868 will be required to provide IRS tax transcripts prior to disbursement of aid. 6
Student s Name: PBSC ID: Individuals Who Filed an Amended IRS Income Tax Return If an individual filed an amended IRS income tax return for tax year 2015, provide all of the following: A signed copy of the original 2015 IRS income tax return that was filed with the IRS or a 2015 IRS Tax Return Transcript (signature not required) for the 2015 tax year; and A signed copy of the 2015 IRS Form 1040X, Amended U.S. Individual Income Tax Return, that was filed with the IRS. An IRS Tax Return Transcript or acceptable IRS alternative such as Form (RTFTP) or Form (IRPTR-W) Individuals Who Filed Non-IRS Income Tax Returns If an individual filed or will file a 2015 income tax return with Puerto Rico, another U.S. territory (e.g., Guam, American Samoa, the U.S. Virgin Islands, the Northern Marianas Islands), or with a foreign country, provide a signed copy of that 2015 income tax return(s). G. Certification and Signatures Student and/or spouse must sign I/we certify that all of the information reported on this worksheet is complete and correct. I/we understand that if I / w e purposely give false or misleading information, I/we could be fined, jailed, or both. Student s Signature Date Parents Signature Date 7