SAR Sample Acknowledgement

STUDENT AID REPORT
ACKNOWLEDGEMENT
2012 - 2013

Dear

1-800-4-FED-AID (1-800-433-3243)
(TTY: 1-800-730-8913)

OMB No. 1845-0008

DATA RELEASE NUMBER (DRN): 2245
EXPECTED FAMILY CONTRIBUTION (EFC): 00000 C

11

F 211 1213

20

WWW.FAFSA.GOV
AUGUST 21, 2012
000117C041
JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

JOHN SMITH,

R

6,

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2012 - 2013
Free Application for Federal Student Aid (FAFSA).

SE

PT

EM

BE

Application Status (review the checked boxes)
) Your FAFSA appears to be complete. Review the data on page 2 and 3. We may have assumed certain information to
calculate your eligibility for federal student aid. We printed any assumptions we made and the word "assumed" for the
items on the back of this page. If you need to make corrections, you can go to www.fafsa.gov and use your Federal
Student Aid PIN to access your information or you can contact the financial aid office at one of the schools you listed
on your application for assistance. The school(s) listed on your FAFSA will receive your information.

E:

Federal Student Aid Eligibility (review the checked boxes)

AT

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 00000.

D

R

AF

T

D

The EFC is not the amount of money that your family must provide. Rather, you should think of the EFC as an index that
colleges use to determine how much financial aid you would receive if you were to attend their school. Financial aid may
include grants (free funds that do not have to be repaid), low-interest loans (borrowed funds that must be repaid), and/or
work-study (paid part-time employment). This award information will vary from college to college because the cost of
attending each is different. Please note that your EFC is subject to change if you update or correct your FAFSA. For more
information about the EFC and other sources of aid, go to www.FederalStudentAid.ed.gov/aidinfo.
) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $5350, in addition to other
grants, low-interest student loans, and work-study opportunities. Your FAA will determine what types of aid and how
much you are eligible to receive.
) We sent your information to other federal agencies through computer matching programs to verify your eligibility for
federal student aid and there appears to be an issue with the information provided on your application. You can
review information about these issues by going to www.fafsa.gov and selecting “View and Print Your Student Aid
Report.” You must work with your financial aid office to resolve any data matching issues before we can determine if
you are eligible to receive federal student aid.
) Unless you are completing the verification process, it may be too late for you to make corrections or give us any more
information this year. If you are completing verification and you need to correct your information, contact the FAA at
your school for assistance. We must have your corrections no later than September 23, 2013.
You should keep this SAR Acknowledgement for your records!
999999C999

PAGE 1 OF 3

01234567891SM01

This section contains information from your student aid application (shaded items display parents' information, if provided). If you need to make
corrections, visit www.fafsa.gov or contact the financial aid office at your college.
1. LAST NAME
SMITH
2. FIRST NAME
JOHN
3. MIDDLE INITIAL
4. ADDRESS 12344 ABCDEFGHIJKLMNOPQRSTUVWXYZABC
5. CITY
ABCDEFGHIJKLMNOP
6. STATE ABBREVIATION
AB
7. ZIP CODE
12345
8. SOCIAL SECURITY NUMBER
XXX-XX-1234
9. DATE OF BIRTH
JANUARY 30, 1986
10. PERMANENT HOME PHONE NUMBER
(999)999-9999
11. DRIVER'S LICENSE NUMBER
A-1234-446-789-012-3
12. DRIVER'S LICENSE STATE ABBREVIATION
AB
13. ST E-MAIL
(ELIG NONCIT ASSUMED)
14. CITIZENSHIP STATUS
15. ALIEN REGISTRATION NUMBER
A123446789
16. MARITAL STATUS
(MARRIED ASSUMED)
17. DATE OF MARITAL STATUS
JANUARY 1993
18. STATE OF LEGAL RESIDENCE ABBREVIATION AB
19. LEGAL RESIDENT BEFORE JANUARY 1, 2007?
20. DATE YOU BECAME A LEGAL RESIDENT
JANUARY 1962
21. ARE YOU MALE OR FEMALE?
MALE
22. REGISTER YOU FOR SELECTIVE SERVICE?
REGISTER ME
23. DRUG CONVICTION AFFECTING ELIGIBILITY? ELIGIBLE FOR AID
24. FATHER'S EDUCATIONAL LEVEL
COLLEGE
25. MOTHER'S EDUCATIONAL LEVEL
COLLEGE
26. HIGH SCHOOL COMPLETION STATUS?
HS DIPLOMA
27.a HS NAME PRINCE GEORGE'S COUNTY HIGH SCHOOL
27.b HS CITY BELTSVILLE
27.c HS STATE MD
28. FIRST BACHELOR'S DEGREE BY 7-1-2012?
YES
29. GRADE LEVEL IN COLLEGE IN 2012-2013
1ST PREV ATTENDED
30. TYPE OF DEGREE/CERTIFICATE
1ST BA
31. INTERESTED IN WORK-STUDY?
YES
32. FILED 2011 INCOME TAX RETURN
WILL FILE
33. TYPE OF 2011 TAX FORM USED
U.S. TRUST TERRITORY
34. ELIGIBLE TO FILE 1040A OR 1040EZ?
YES
35. ADJUSTED GROSS INCOME FROM IRS FORM $ (-123,446 ASSUMED)
36. U.S. INCOME TAX PAID
$ (0 ASSUMED)
37. EXEMPTIONS CLAIMED
00
38. STUDENT'S INCOME EARNED FROM WORK $ (123,446 ASSUMED)
39. SPOUSE'S INCOME EARNED FROM WORK $ (123,446 ASSUMED)
40. CASH, SAVINGS, AND CHECKING
$ 123,446
41. NET WORTH OF INVESTMENTS
$ 123,446

999999C999

42. NET WORTH OF BUSINESS/INVESTMENT FARMS
$ 123,446
43. STUDENT'S ADDITIONAL FINANCIAL INFORMATION
a) EDUCATION CREDITS
$ 12,344
b) CHILD SUPPORT PAID
$ 12,344
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
$ 12,344
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 12,344
$
e) SPECIAL COMBAT PAY/COMBAT PAY
f) COOPERATIVE EDUCATION PROGRAM EARNINGS $
44. STUDENT'S UNTAXED INCOME
$ 12,344
a) TAX-DEFERRED PENSION/SAVINGS
$ 12,344
b) IRA DEDUCTIONS AND PAYMENTS
$ 12,344
c) CHILD SUPPORT RECEIVED
$ 12,344
d) TAX EXEMPT INTEREST INCOME
$ 12,344
e) UNTAXED IRA DISTRIBUTIONS
$ 12,344
f) UNTAXED PORTIONS OF PENSIONS
$ 12,344
g) MILITARY OR CLERGY ALLOWANCES
$ 12,344
h) VETERANS NON EDUCATION BENEFITS
$ 12,344
i) OTHER UNTAXED INCOME
j) MONEY RECEIVED OR PAID ON YOUR BEHALF
$ 12,344
YES
45. BORN BEFORE 1-1-1989?
YES
46. ARE YOU MARRIED?
47. WORKING ON MASTER'S OR DOCTORATE?
YES
48. ON ACTIVE DUTY IN U.S. ARMED FORCES?
YES
49. VETERAN OF U.S. ARMED FORCES?
YES
YES
50. HAVE CHILDREN YOU SUPPORT?
YES
51. DEPENDENTS OTHER THAN CHILDREN/SPOUSE?
52. PARENTS DECEASED, FOSTER CARE, WARD OF COURT? YES
YES
53. ARE/WERE AN EMANCIPATED MINOR?
YES
54. ARE/WERE IN LEGAL GUARDIANSHIP?
YES
55. VERIFIED AS A HOMELESS CHILD OR YOUTH?
56. DETERMINED BY DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT THAT YOU WERE HOMELESS?
YES
57. VERIFIED AS UNACCOMPANIED YOUTH AT RISK FOR
YES
HOMELESS?
(MARRIED ASSUMED)
58. PARENTS' MARITAL STATUS
DECEMBER 1958
59. PARENTS' MARITAL STATUS DATE
60. YOUR FATHER'S SOCIAL SECURITY NUMBER XXX-XX-1234
ABCDEFGHIJKLMNOP
61. YOUR FATHER'S LAST NAME
62. YOUR FATHER'S FIRST INITIAL
X
JANUARY 23, 1958
63. YOUR FATHER'S DATE OF BIRTH
64. YOUR MOTHER'S SOCIAL SECURITY NUMBER XXX-XX-1234
ABCDEFGHIJKLMNOP
65. YOUR MOTHER'S LAST NAME
66. YOUR MOTHER'S FIRST INITIAL
D
67. YOUR MOTHER'S DATE OF BIRTH
JANUARY 24, 1958
68. PAR EMAIL [email protected]
69. PARENTS' STATE OF LEGAL RESIDENCE
AB

PAGE 2 OF 3

01234567891SM01

70. LEGAL RESIDENT BEFORE JANUARY 1, 2007? NO
DECEMBER 2008
71. DATE PARENT BECAME LEGAL RESIDENT
72. NUMBER OF FAMILY MEMBERS IN 2012-2013 03
2
73. NUMBER IN COLLEGE IN 2012-2013
YES
93. NUMBER OF FAMILY MEMBERS IN 2012-2013
74. PARENT RECEIVED SSI?
YES
94. NUMBER IN COLLEGE IN 2012-2013
75. RECEIVED FOOD STAMPS?
76. RECEIVED FREE/REDUCED PRICE LUNCH? YES
NO
95. STUDENT RECEIVED SSI?
77. RECEIVED TANF?
YES
96. RECEIVED FOOD STAMPS?
NO
YES
78. RECEIVED WIC?
NO
97. RECEIVED FREE/REDUCED PRICE LUNCH?
WILL FILE
79. PARENT(S) FILED 2011 TAX RETURN
NO
98. RECEIVED TANF?
U.S.
TRUST
TERRITORY
80. TYPE OF 2011 TAX FORM USED
99. RECEIVED WIC?
YES
100. STUDENT OR SPOUSE A DISLOCATED WORKER?
81. ELIGIBLE TO FILE A 1040A OR 1040EZ?
NO
101.a FIRST COLLEGE NAME
82. EITHER OF PARENTS A DISLOCATED WORKER? YES
THE PENNSYLVANIA STATE UNIVERSITY NEW KENSINGTON CAMPUS COMMON
83. ADJUSTED GROSS INCOME FROM IRS FORM $ (-123,456 ASSUMED)
(0
ASSUMED)
84. U.S. INCOME TAX PAID
$
03
85. EXEMPTIONS CLAIMED
101.b FIRST HOUSING PLAN ON CAMPUS
$ (123,456 ASSUMED)
86. FATHER'S INCOME EARNED FROM WORK
101.c SECOND COLLEGE NAME
87. MOTHER'S INCOME EARNED FROM WORK $ (123,456 ASSUMED)
ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWXYZABCD
$ 123,456
88. CASH, SAVINGS AND CHECKING
123,456
$
89. NET WORTH OF INVESTMENTS
90. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 123,456
101.d SECOND HOUSING PLAN OFF CAMPUS
91. PARENTS' ADDITIONAL FINANCIAL INFORMATION
101.e THIRD COLLEGE NAME
$ 112,345
a) EDUCATION CREDITS
ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWXYZABCD
b) CHILD SUPPORT PAID
$ 112,345
$ 112,345
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 112,345
101.f THIRD HOUSING PLAN ON CAMPUS
$ 112,345
e) SPECIAL COMBAT PAY/COMBAT PAY
101.g FOURTH COLLEGE NAME
$ 112,345
f) COOPERATIVE EDUCATION PROGRAM EARNINGS
ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWXYZABCD
92. PARENTS' UNTAXED INCOME
$ 112,345
a) TAX-DEFERRED PENSION/SAVINGS
$ 112,345
b) IRA DEDUCTIONS AND PAYMENTS
101.h FOURTH HOUSING PLAN OFF CAMPUS
$ 112,345
c) CHILD SUPPORT RECEIVED
NOVEMBER 23, 2012
102. DATE COMPLETED
$ 112,345
d) TAX EXEMPT INTEREST INCOME
STUDENT
103. SIGNED BY
$ 112,345
e) UNTAXED IRA DISTRIBUTIONS
104. PREPARER'S SOCIAL SECURITY NUMBER REPORTED
$ 112,345
f) UNTAXED PORTIONS OF PENSIONS
REPORTED
105. PREPARER'S EIN
$ 112,345
g) MILITARY OR CLERGY ALLOWANCES
SIGNED
106. PREPARER'S SIGNATURE
$ 112,345
h) VETERANS NON EDUCATION BENEFITS
$ 112,345
i) OTHER UNTAXED INCOME
Your FAFSA information was sent to all colleges you listed although they are not all shown here. To see all of the colleges you listed go to
www.fafsa.gov and select "View and Print Your Student Aid Report".
4A
Transaction Source:
Verification Flag:
Y
Y
SAR C Flag:
Application Receipt Date: 04/21/2012
Transaction Process Date: 04/21/2012
Transaction Receipt Date: 04/21/2012
IRS Flag: Student: Parent:
4
SSN Match Flag:
DHS Match Flag:
4
8
DHS Sec. Conf. Flag:
2
NSLDS Match Flag:

For Financial Aid Office Use Only

Expected Family Contribution: Primary 00000
Secondary 00000
Y
Automatic Zero EFC Flag:
2
Formula Type:
Y
Simplified Needs Test Flag:
Special Circumstances:
1
Y
High School Flag:
N
Selective Service Registration Flag:
DHS Verification #:
999999999999999
N
VA Match Flag:
1
NSLDS Results Flag:
1
NSLDS Transaction Number:

Professional Judgment:
Dependency Status:
Dependency Override:
Hold Code:
Pell Eligible Flag:
Duplicate SSN Flag:

Y
X
Y
N

Selective Service Match:
SSA Citizenship Code: A
4
FSSN Match Flag:
8
MSSN Match Flag:

Reject Code(s): 01 02 03 04 05 06 07
Comment Codes: 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020
999999C999

PAGE 3 OF 3

01234567891SM01