2023-2024 Student Aid Report Acknowledgement (SAR ACK)

STUDENT AID REPORT
ACKNOWLEDGEMENT
2023-2024
HTTPS://FAFSA.GOV
NOVEMBER 23, 2023

DATA RELEASE NUMBER (DRN): 2245
EXPECTED FAMILY CONTRIBUTION (EFC): 000000 C

F 211 2324

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000117C041

OMB No. 1845-0001

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JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

Dear JOHN SMITH,

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2023-2024
Free Application for Federal Student Aid (FAFSA).
Application Status (review the checked boxes)

) Your FAFSA appears to be complete. Review the data on pages 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 https://fafsa.gov and use your FSA ID
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.

Federal Student Aid Eligibility (review the checked boxes)

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 000000.

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), work-study (paid part-time employment), and/or low-interest
loans (borrowed funds that must be repaid). 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 StudentAid.gov.
) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $6895, provided you have not
met or exceeded the lifetime limit established for the Federal Pell Grant program. You may also be eligible for other
grants, work-study opportunities, and low-interest student loans. Your Financial Aid Administrator (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 https://fafsa.gov and selecting “View or Print your Student Aid
Report (SAR)” after logging in. 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 Financial Aid Administrator (FAA) at your school for assistance. We must have your corrections no later than
September 14, 2024.
You should keep this SAR Acknowledgement for your records!
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This section contains information from your student aid application (shaded items display parents' information, if provided). If you need to make
corrections, visit https://fafsa.gov or contact the financial aid office at your college.

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40. STUDENT'S ADDITIONAL FINANCIAL INFORMATION
$ 1,123,456
a) EDUCATION CREDITS
$ 1,123,456
b) CHILD SUPPORT PAID
$ 1,123,456
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
d) COLLEGE GRANT AND SCHOLARSHIP AID REPORTED $ 1,123,456
$ 1,123,456
e) COMBAT PAY/SPECIAL COMBAT PAY
f) COOPERATIVE EDUCATION PROGRAM EARNINGS $ 1,123,456
41. STUDENT'S UNTAXED INCOME
a) TAX-DEFERRED PENSIONS/SAVINGS
$ 1,123,456
$ 1,123,456
b) IRA DEDUCTIONS AND PAYMENTS
$ 1,123,456
c) CHILD SUPPORT RECEIVED
d) TAX-EXEMPT INTEREST INCOME
$ 1,123,456
e) UNTAXED PORTIONS OF IRA DISTRIBUTIONS/PENSIONS $ 1,123,456
$ 1,123,456
f) MILITARY OR CLERGY ALLOWANCES
$ 1,123,456
g) VETERANS NONEDUCATION BENEFITS
h) OTHER UNTAXED INCOME
$ 1,123,456
$ 1,123,456
i) MONEY RECEIVED OR PAID ON YOUR BEHALF
YES
42. BORN BEFORE 1-1-2000?
43. ARE YOU MARRIED?
YES
44. WORKING ON MASTER'S OR DOCTORATE?
YES
YES
45. ON ACTIVE DUTY IN U.S. ARMED FORCES?
YES
46. VETERAN OF U.S. ARMED FORCES?
YES
47. HAVE CHILDREN YOU SUPPORT?
YES
48. DEPENDENTS OTHER THAN CHILDREN/SPOUSE?
49. PARENTS DECEASED, FOSTER CARE, WARD OF COURT? YES
YES
50. ARE/WERE AN EMANCIPATED MINOR?
YES
51. ARE/WERE IN LEGAL GUARDIANSHIP?
52. HOMELESS AS DETERMINED BY HIGH SCHOOL LIAISON? YES
YES
53. HOMELESS AS DETERMINED BY HUD?
54. HOMELESS AS DETERMINED BY DIRECTOR OF
YES
HOMELESS YOUTH CENTER?
55. PARENTS' MARITAL STATUS UNMARRIED AND BOTH PARENTS LIVING
TOGETHER
DECEMBER 1990
56. PARENTS' MARITAL STATUS DATE
XXX-XX-1234
57. PARENT 1 SOCIAL SECURITY NUMBER
ABCDEFGHIJKLMNOP
58. PARENT 1 LAST NAME
59. PARENT 1 FIRST INITIAL
B
60. PARENT 1 DATE OF BIRTH
JANUARY 23, 1973
61. PARENT 2 SOCIAL SECURITY NUMBER
XXX-XX-5678
ABCDEFGHIJKLMNOP
62. PARENT 2 LAST NAME
C
63. PARENT 2 FIRST INITIAL
64. PARENT 2 DATE OF BIRTH
JANUARY 24, 1974
65. PAR EMAIL [email protected]
66. PARENTS' STATE OF LEGAL RESIDENCE
AB
67. LEGAL RESIDENT BEFORE JANUARY 1, 2018? NO
68. DATE PARENT BECAME LEGAL RESIDENT
DECEMBER 2012

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1. LAST NAME
SMITH
2. FIRST NAME
JOHN
3. MIDDLE INITIAL
B
4. ADDRESS 12344 ABCDEFGHIJKLMNOPQRSTUVWXYZ123
ABCDEFGHIJKLMNOP
5. CITY
6. STATE ABBREVIATION
AB
55555
7. ZIP CODE
8. SOCIAL SECURITY NUMBER
XXX-XX-1234
9. DATE OF BIRTH
JANUARY 30, 1992
10. YOUR TELEPHONE NUMBER
(999) 999-9999
A-1234-567-890-123-4
11. DRIVER'S LICENSE NUMBER
12. DRIVER'S LICENSE STATE ABBREVIATION
AB
13. ST E-MAIL [email protected]
(ELIG NONCIT ASSUMED)
14. CITIZENSHIP STATUS
A123456789
15. ALIEN REGISTRATION NUMBER
(MARRIED ASSUMED)
16. MARITAL STATUS
JANUARY 2015
17. DATE OF MARITAL STATUS
18. STATE OF LEGAL RESIDENCE ABBREVIATION AB
19. LEGAL RESIDENT BEFORE JANUARY 1, 2018? NO
FEBRUARY 2012
20. DATE YOU BECAME A LEGAL RESIDENT
21. PARENT 1 EDUCATIONAL LEVEL
COLLEGE
22. PARENT 2 EDUCATIONAL LEVEL
COLLEGE
23. HIGH SCHOOL COMPLETION STATUS? GED/STATE CERTIFICATE
24.a HS NAME PRINCE GEORGE'S COUNTY HIGH SCHOOL
24.b HS CITY BELTSVILLE
24.c HS STATE MD
YES
25. FIRST BACHELOR'S DEGREE BY 7-1-2023?
26. GRADE LEVEL IN COLLEGE IN 2023-2024
1ST PREV ATTENDED
1ST BA
27. TYPE OF DEGREE/CERTIFICATE
YES
28. INTERESTED IN WORK-STUDY?
29. FILED 2021 INCOME TAX RETURN
WILL FILE
30. TYPE OF 2021 TAX FORM USED
IRS FORM 1040
31. TAX RETURN FILING STATUS 2021
MARRIED-FILED SEPARATE
RETURN
32. STUDENT FILED SCHEDULE 1?
YES
33. ADJUSTED GROSS INCOME FROM IRS FORM $ (-1,123,456 ASSUMED)
$ (0 ASSUMED)
34. U.S. INCOME TAX PAID
35. STUDENT'S INCOME EARNED FROM WORK $ (1,123,456 ASSUMED)
36. SPOUSE'S INCOME EARNED FROM WORK $ (1,123,456 ASSUMED)
$ 1,123,456
37. CASH, SAVINGS, AND CHECKING
$ 1,123,456
38. NET WORTH OF INVESTMENTS
39. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 1,123,456

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90. NUMBER OF FAMILY MEMBERS IN 2023-2024
91. NUMBER IN COLLEGE IN 2023-2024
92. STUDENT RECEIVED MEDICAID OR SSI?
93. RECEIVED SNAP?
94. RECEIVED FREE/REDUCED PRICE LUNCH?
95. RECEIVED TANF?
96. RECEIVED WIC?
97. STUDENT OR SPOUSE A DISLOCATED WORKER?
98.a FIRST COLLEGE NAME
THE PENNSYLVANIA STATE UNIVERSITY

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03
2
YES
YES
YES
YES
YES
WILL FILE
IRS FORM 1040
MARRIED-FILED SEPARATE
RETURN
DON'T KNOW
79. PARENT FILED SCHEDULE 1?
80. EITHER OF PARENTS A DISLOCATED WORKER? YES
81. ADJUSTED GROSS INCOME FROM IRS FORM $ (-1,123,456 ASSUMED)
82. U.S. INCOME TAX PAID
$ (0 ASSUMED)
83. PARENT 1 INCOME EARNED FROM WORK
$ (1,123,456 ASSUMED)
84. PARENT 2 INCOME EARNED FROM WORK
$ (1,123,456 ASSUMED)
85. CASH, SAVINGS, AND CHECKING
$ 1,123,456
86. NET WORTH OF INVESTMENTS
$ 1,123,456
87. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 1,123,456
88. PARENTS' ADDITIONAL FINANCIAL INFORMATION
a) EDUCATION CREDITS
$ 1,112,345
b) CHILD SUPPORT PAID
$ 1,112,345
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
$ 1,112,345
d) COLLEGE GRANT AND SCHOLARSHIP AID REPORTED $ 1,112,345
$ 1,112,345
e) COMBAT PAY/SPECIAL COMBAT PAY
f) COOPERATIVE EDUCATION PROGRAM EARNINGS
$ 1,112,345
89. PARENTS' UNTAXED INCOME
a) TAX-DEFERRED PENSIONS/SAVINGS
$ 1,112,345
b) IRA DEDUCTIONS AND PAYMENTS
$ 1,112,345
c) CHILD SUPPORT RECEIVED
$ 1,112,345
d) TAX-EXEMPT INTEREST INCOME
$ 1,112,345
e) UNTAXED PORTIONS OF IRA DISTRIBUTIONS/PENSIONS $ 1,112,345
f) MILITARY OR CLERGY ALLOWANCES
$ 1,112,345
g) VETERANS NONEDUCATION BENEFITS
$ 1,112,345
h) OTHER UNTAXED INCOME
$ 1,112,345

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69. NUMBER OF FAMILY MEMBERS IN 2023-2024
70. NUMBER IN COLLEGE IN 2023-2024
71. PARENT RECEIVED MEDICAID OR SSI?
72. RECEIVED SNAP?
73. RECEIVED FREE/REDUCED PRICE LUNCH?
74. RECEIVED TANF?
75. RECEIVED WIC?
76. PARENT(S) FILED 2021 TAX RETURN
77. TYPE OF 2021 TAX FORM USED
78. TAX RETURN FILING STATUS 2021

4
2
NO
NO
NO
NO
NO
NO

98.b FIRST HOUSING PLAN ON CAMPUS
98.c SECOND COLLEGE NAME

MISSOURI STATE UNIVERSITY

98.d SECOND HOUSING PLAN OFF CAMPUS
98.e THIRD COLLEGE NAME

TEXAS STATE UNIVERSITY

98.f THIRD HOUSING PLAN ON CAMPUS
98.g FOURTH COLLEGE NAME

UNIVERSITY OF MASSACHUSETTS

98.h FOURTH HOUSING PLAN OFF CAMPUS
99. DATE COMPLETED
100. SIGNED BY
101. PREPARER'S SOCIAL SECURITY NUMBER
102. PREPARER'S EIN
103. PREPARER'S SIGNATURE

NOVEMBER 23,2023
STUDENT
REPORTED
REPORTED
SIGNED

Your FAFSA information was sent to all the colleges you listed although they are not all shown here. To see all of the colleges you listed, go to
https://fafsa.gov and select "View or Print your Student Aid Report (SAR)" after logging in.

For Financial Aid Office Use Only

Verification Selection Change Flag: C
Transaction Source:
Expected Family Contribution: Primary 000000
Professional Judgment: Y
2A
Verification Flag:
Secondary 000000
Dependency Status:
Y
X
Y
Automatic Zero EFC Flag:
Y
SAR C Flag:
Dependency Override:
Formula Type:
2
Application Receipt Date: 11/23/2023
Hold Code:
Simplified Needs Test Flag:
Y
Transaction Process Date: 11/23/2023
Duplicate SSN Flag:
1
1
Transaction Receipt Date: 11/23/2023
Pell Eligible Flag:
Y
Special Circumstances:
Y
High School Flag:
IRS Request Flag: Student: 01 Parent: 01
IRS Display Flag: Student: A Parent: C
SSN Match Flag:
4
N
A
VA Match Flag:
SSA Citizenship Code:
NSLDS Results Flag:
DHS Match Flag:
1
4
4
P1SSN Match Flag:
01
999999999999999
8
DHS Verification #:
P2SSN Match Flag:
NSLDS Transaction Number:
NSLDS Match Flag:
2
8
Y
DHS Sec. Conf. Flag:
CFH Indicator:
NSLDS Unusual Enrollment History Flag: 1
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
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