Subpart E Verfication: State, Local, or Tribal

2012–2013 Verification Worksheet
Independent 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 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 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. Independent 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. Independent Student’s Family Information
List below the people in your household. Include:
 Yourself.
 Your spouse, if you are married.
 Your children, if any, if you will provide more than half of their support from July 1, 2012, through June 30, 2013, or if
the child would be required to provide your 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 you.
 Other people if they now live with you and you 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 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 your name and Social Security Number at the top.
Full Name
Marty Jones(example)

Age

Relationship

College

28

Wife
Self

Central University

Will be Enrolled at
Least Half Time
Yes

Student’s Name: ______________________________________________ SSN: __________________________
C. Independent Student’s Income Information to Be Verified
1. TAX RETURN FILERS—Important Note: If you (or your spouse, if married) filed, or will file, an amended 2011 IRS tax
return, you must contact your financial aid administrator before completing this section.
Instructions: Complete this section if you, 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 you have not already used the tool,
go to FAFSA.gov, log in to your FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information
section of the form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to
transfer 2011 IRS income tax information into your 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:
I, the student, have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my (and, if married, my spouse’s)
2011 IRS income information into my FAFSA, either on the initial FAFSA or when making a correction to the FAFSA.
Your school will use the IRS information that was transferred in the verification process.
I, the student, have not yet used the IRS Data Retrieval Tool, but I will use the tool to transfer my (and, if married, my
spouse’s) 2011 IRS income information into my FAFSA once I have filed my 2011 IRS tax return. See instructions above
for information on how to use the IRS Data Retrieval Tool. Your school cannot complete the verification process until your
(and, if married, your spouse’s) IRS information has been transferred into your FAFSA.
I, the student, am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and I will submit to the
school 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 1-800-908-9946.
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 your
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. If you are married and you and your spouse filed
separate 2011 tax returns, you must submit tax return transcripts for both you and your spouse.
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 your school later. Verification cannot be completed
until the IRS tax return transcript(s) has been submitted to your school.
2. TAX RETURN NONFILERS—Complete this section if you, the student (and, if married, your spouse), will not file and are
not required to file a 2011 income tax return with the IRS.
Check the box that applies:
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2011.
The student (and/or the student’s spouse if married) was employed in 2011 and has listed below the names of all
employers, the amount earned from each employer in 2011, and whether an IRS W-2 form is attached. Attach copies of all
2011 W-2 forms issued to you (and, if married, to your spouse) by employers. List every employer even if the employer did
not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and SSN at the top.
Employer’s Name
Suzy’s Auto Body Shop (example)

2011 Amount Earned
$2,000.00

IRS W-2 Attached?
Yes

Student’s Name: ______________________________________________ SSN: __________________________
D. Independent Student’s Other Information to Be Verified
1. Complete this section if someone in the student’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 my school, I
will provide documentation of the receipt of SNAP benefits during 2010 and/or 2011.
2. Complete this section if you or your spouse, if married, paid child support in 2011.
Either I, or if married my spouse who is listed in Section B of this worksheet, paid child support in 2011. I have 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 my school, I will provide documentation of the payment of child support. If you need more
space, attach a separate page that includes your 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(example)

Chris Smith

Terry Jones

Amount of Child
Support Paid in
2011
$6,000.00

E. Certification and Signature
I certify that all of the information reported on this
worksheet is complete and correct. The student must
sign this worksheet. If married, the spouse’s signature
is optional.

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

_________________________________________________
Spouse’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.