Sample model Verification worksheet Dependent student

2012–2013 Verification Worksheet
Dependent Student
Your 2012–2013 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 Social Security 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, 2012, through
June 30, 2013, or if the other children would be required to provide parental information if they were completing a FAFSA
for 2012–2013. 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, 2013.
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, 2012, and June
30, 2013. If more space is needed, attach a separate page with the student’s name and Social Security Number at the top.
Full Name
Missy Jones (example)

Age

Relationship

College

18

Sister
Self

Central University

Will be Enrolled at
Least Half Time
Yes

Student’s Name: ______________________________________________ SSN: __________________________
C. Dependent Student’s Income Information to Be Verified
1. TAX RETURN FILERS—Important Note: If the student filed, or will file, an amended 2011 IRS tax return, the student must
contact the financial aid administrator before completing this section.
Instructions: Complete this section if the student, filed or will file a 2011 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 2011 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.
Check the box that applies:
The student has used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and transfer 2011 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 has not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to retrieve and
transfer 2011 IRS income information into the student’s FAFSA once the student has filed a 2011 IRS tax return. See
instructions above for information on how to use the IRS Data Retrieval Tool. The student’s school cannot complete the
verification process until the IRS information has been transferred into the FAFSA.
The student is unable or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and the student will submit
to the school a 2011 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 on the “Order a Return or Account 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 2011
IRS tax return was filed). It takes up to two weeks for IRS income information to be available for electronic IRS tax return
filers, and up to eight weeks for paper IRS tax return filers.
Check here if the student’s IRS tax return transcript is attached to this worksheet.
Check here if the student’s IRS tax return transcript will be submitted to the student’s school later. Verification
cannot be completed until the IRS tax return transcript has been submitted to the student’s school.
2. TAX RETURN NONFILERS—Complete this section if the student, will not file and is not required to file a 2011 income tax
return with the IRS.
Check the box that applies:
The student was not employed and had no income earned from work in 2011.
The student was employed in 2011 and has listed below the names of all the student’s employers, the amount earned from
each employer in 2011, and whether an IRS W-2 form is attached. Attach copies of all 2011 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 Social Security Number at the top.
Employer’s Name
Suzy’s Auto Body Shop (example)

2011 Amount Earned
$2,000.00(example)

IRS W-2 Attached?
Yes(example)

Student’s Name: ______________________________________________ SSN: __________________________
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: If the student’s parent(s), filed or will file, an amended 2011 IRS tax return the
student’s financial aid administrator must be contacted before completing this section.
Instructions: Complete this section if the student’s parent(s) filed or will file a 2011 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 2011 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.
Check the box that applies:
The student’s parent has used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2011 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’s parent has not yet used the IRS Data Retrieval Tool, but will use the tool to transfer 2011 IRS income
information into the student’s FAFSA once the parent’s IRS tax return has been filed. See instructions above for
information on how to use the IRS Data Retrieval Tool. The student’s financial aid administrator cannot complete
verification until the parent has transferred IRS information into the student’s FAFSA.
The parent is unable or chooses not to use the IRS Data Retrieval Tool, and the parent will submit to the student’s school a
copy of the parent’s 2011 IRS tax return transcript(s)—not photocopies of the income tax return. To obtain an IRS tax
return transcript go to www.IRS.gov and click on the “Order a Return or Account Transcript” link, or call 1-800-9089946. Make sure you order the “IRS tax return transcript” and not the “IRS tax account transcript.” The parent will need
his or her Social Security Number, date of birth, and the address on file with the IRS (normally this will be the address
used when the 2011 IRS tax return was filed). It takes up to two weeks for IRS income information to be available for
electronic IRS tax return filers, and up to eight weeks for paper tax return filers. If the parents are married, and separate
2011 tax returns were filed, 2011 IRS tax return transcripts must be submitted for each parent.
Check here if an IRS tax return transcript(s) is attached to this worksheet.
Check here if IRS tax return transcript(s) will be submitted to the student’s school later. Verification cannot be
completed until the IRS tax return transcript(s) has been submitted to the school.
2. TAX RETURN NONFILERS—Complete this section if the student’s parent(s) will not file and is not required to file a 2011
income tax return with the IRS.
Check the box that applies:
The parent(s) was not employed and had no income earned from work in 2011.
The parent(s) was employed in 2011 and has listed below the names of all the parent’s employers, the amount earned from
each employer in 2011, and whether an IRS W-2 form is attached. Attach copies of all 2011 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 Social Security Number at the top.
Employer’s Name
Suzy’s Auto Body Shop (example)

2011 Amount Earned
$2,000.00 (example)

IRS W-2 Attached?
Yes (example)

Student’s Name: ______________________________________________ SSN: __________________________
E. Parent’s Other Information to Be Verified
1. Complete this section if someone in the student’s parent’s household (listed in Section B) received benefits from the
Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2010 or 2011
calendar years.
One of the persons listed in Section B of this worksheet received SNAP benefits in 2010 or 2011. If asked by the student’s
school, I will provide documentation of the receipt of SNAP benefits during 2010 and/or 2011.
2. Complete this section if one of the student’s parents paid child support in 2011.
One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2011. The parent has
indicated below the name of the person who paid the child support, the name of the person to whom the child support was
paid, the names of the children for whom child support was paid, and the total annual amount of child support that was
paid in 2011 for each child. If asked by the school, I will provide documentation of the payment of child support. If you
need more space, attach a separate page that includes the student’s name and Social Security Number at the top.

Name of Person Who Paid
Child Support

Name of Person to Whom Child
Support was Paid

Name of Child for Whom
Support Was Paid

Marty Jones

Chris Smith (example)

Terry Jones

Amount of Child
Support Paid in
2011
$6,000.00

F. Certification and Signatures
Each person signing this worksheet certifies that all of the
information reported on it is complete and correct.
The student and one parent must sign and date.

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

_________________________________________________
Student’s Signature

_________________________________
Date

_________________________________________________
Parent’s Signature

_________________________________
Date

Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to the financial aid administrator at your school.
You should make a copy of this worksheet for your records.