Form 1845-0041 Verification worksheet (This is an optional form.)

2007-2008 Verification Worksheet
U.S. Department
of Education

Dependent

Federal Student Aid Programs

Your application was selected for review in a process called
“Verification.” In this process, your school will be comparing
information from your application with signed copies of your
and your parent(s)’ 2006 Federal tax forms, or with W-2 forms or
other financial documents. The law says we have the right to ask
you for this information before awarding Federal aid. If there are
differences between your application information and your financial documents, you or your school may need to make corrections
electronically or by using your Student Aid Report (SAR).
Complete this verification form and submit it to your financial aid
administrator as soon as possible, so that your financial aid won’t
be delayed. Your financial aid administrator will help you.

A. Student Information
Last name

First name

What you should do

1. Collect your and your parent(s)’ financial documents (signed
Federal income tax forms, W-2 forms, etc.).
2. Talk to your financial aid administrator if you have questions
about completing this worksheet.
3. Complete and sign the worksheet—you and at least one
parent.
4. Submit the completed worksheet, tax forms, and any other
documents your school requests to your financial aid
administrator.
5. Your financial aid administrator will compare information on
this worksheet and any supporting documents with the
information you submitted on your application. You may
need to make corrections electronically or by using your SAR.
Your school must review the requested information, under the
financial aid program rules (34 CFR, Part 668).

M.I.

Social Security Number
Date of birth

Address (include apt. no.)
City

FORM APPROVED
OMB NO. 1845-0041

State

ZIP code

Phone number (include area code)

B. Family Information
List the people in your parents’ household, include:
• yourself and your parent(s) (including stepparent) even if you don’t live with your parents, and
• your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more than half of their
support from July 1, 2007 through June 30, 2008, or (b) the children would be required to provide parental information when
applying for Federal Student Aid, and
• other people if they now live with your parents, and your parents provide more than half of their support and
will continue to provide more than half of their support from July 1, 2007 through June 30, 2008.
Write the names of all household members in the space(s) below. Also write in the name of the college for any household member,
excluding your parent(s), who will be attending college at least half time between July 1, 2007 and June 30, 2008, and will be enrolled
in a degree, diploma, or certificate program. If you need more space, attach a separate page.
Full Name

Missy Jones (example)

Age

18

Relationship

Sister

College

Central University

Self

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 1845-0041. The time required to complete this information collection is estimated to average twelve minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: US Department of Education, Washington, DC 20202-5345.

Dependent

C. Student’s Tax Forms and Income Information (all applicants)

1. Check only one box below. Tax returns include the 2006 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto
Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax preparer
or request an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Check here if you will not file and are not required to file a 2006 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See worksheets A&B of the Free Application for
Federal Student Aid (FAFSA))
Sources of Untaxed Income

2006 Amount

a. Child Support
b. Social Security (non-taxed)

d.
e.

$
$
$

c. Welfare (including TANF)

Sources of Untaxed Income

2006 Amount

$
$
$

f.

3. If you did not file and are not required to file a 2006 Federal income tax return, list below your employer(s) and any
income received in 2006 (use the W-2 form or other earnings statements if available).
Sources

2006 Amount

$
$
$

D. Parent(s)’ Tax Forms and Income Information
1. Check only one box below. Tax returns include the 2006 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
foreign income tax return. If your parent(s) did not keep a copy of their tax return, request a copy from the tax preparer or request
an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your parents’ tax return(s).
Check here if a signed tax return(s) will be submitted to the school by ______________________(date).
Check here if your parent(s) will not file and are not required to file a 2006 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See worksheets A & B of the FAFSA.)
Sources of Untaxed Income

2006 Amount

a. Child Support
b. Social Security (non-taxed)

$
$
$

c. Welfare (including TANF)

Sources of Untaxed Income

d.
e.

2006 Amount

$
$
$

f.

3. If your parent(s) did not file and are not required to file a 2006 Federal income tax return, list below your parent(s)’
employer(s) and any income they received in 2006 (use the W-2 form or other earnings statements if available).
Sources

2006 Amount

$
$
$
E. Sign this Worksheet
By signing this worksheet, we certify that all the information reported
on it is complete and correct. At least one parent must sign.

Student

Date

Parent

Date

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

Do not mail this worksheet to the Department of Education. Submit this worksheet to your
Financial Aid Administrator at your school. Make sure that tax forms are signed.