Dependent Verification Worksheet

Dependent
2014-2015 Verification Worksheet

Your application was selected for review in a process called “Verification”. In this process we will be comparing information from your FAFSA
with the information you and your parent(s) submitted to the IRS on your 2013 federal income tax return. If there are differences between the
information you submitted on your FAFSA and your financial documents, we may need to make corrections electronically to your application.
What you must do
1.
2.
3.
4.
Provide your and your parent(s)’ financial and tax information utilizing the FAFSA on the Web IRS Data Retrieval Tool (DRT). In most cases
you can use the DRT within 3 weeks of electronically submitting your Federal Return or 11 weeks after mailing a paper Federal tax return.
If you or your parents are unable to utilize the DRT you may submit an official 2013 Tax Return Transcript.

Request the tax transcript from the IRS by calling 800-908-9946.

You may also submit your request online at www.irs.gov. Click on the 2013 IRS Tax Return Transcript link. Please note that you
must request a tax transcript, an account transcript is not acceptable documentation.

Availability of the transcript, from the date you file your tax return, is the same as the DRT (see above). You should receive your
transcript in 10 to 14 days.
Complete and sign the worksheet --- you and at least one parent.
Submit the completed worksheet, tax transcripts, (if applicable) and any other documents requested of you to: Roanoke College Financial Aid
Office, 221 College Lane, Salem, VA 24153. You may also fax these documents to our office at 540-375-2267 or email them to
[email protected]. Do not mail this form to the Dept. of Education. Contact our office at 800-200-9221 or 540-375-2235 if you have
questions about completing this worksheet.
A. Student Information
_________________________________________________________________
Last
First
Middle
__________________________________________________
Social Security Number
__________________________________________________________________
__________________________________________________
Address (include apt. no.)
Date of birth
__________________________________________________________________
City
State
Zip Code
__________________________________________________
Phone Number (include area code)
B. Family Information
List
the people in your parent(s)’ household, including:
__________________________________________________________________
__________________________________________________

Yourself (even
if you don’t live with your parents); Zip Code
City
State
Phone number (include area code)

Your parent(s) (including stepparent);

Your parents’ other children (even if they don’t live with your parent(s)),
if either of the following is applicable:
______________________________________________________________
__________________________________________________
o Your
parents will provide more than half ofZip
theirCode
support from July
1, number
2014 through
June
30,code)
2015 or,
City
State
Phone
(include
area
o The children would be required to provide parental information when applying for Federal Student Aid

Other people if they now live with your parents and your parents provide more than half of their support . (In order to include other people
in your household size, your parents must continue to provide more than half of their support from July 1, 2014 through June 30, 2015.)
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 at least half time between July 1, 2014 and June 30, 2015, and will be enrolled in a degree, diploma, or certificate
program. If you need more space, attach a separate page.
Full Name
Age
Relationship
College
Self
Roanoke College
C. Supplemental Nutrition Assistance Program (SNAP) Benefits Verification:
Did you or anyone in your household receive benefits from SNAP during 2012 or 2013?
(Please check one) _____ No
_____ Yes
Name of person(s) receiving SNAP benefits _______________________________________________________________________
D. Student’s Income and Tax Information - Check only one box below.




I have utilized the FAFSA IRS Data Retrieval Tool (DRT) AND did not change any of the information that was transferred.
I will submit a correction to the FAFSA and utilize the DRT by _________ (date). I realize that I should NOT change any of the information that
is transferred.
I am unable or choose not to use the DRT and will provide a 2013 IRS Tax Return Transcript instead. (See instructions in step 2 of “What you
must do” on the other side of this form.)
I will not file, and am not required to file, a 2013 Federal Tax Return. (See D 2 below.)
1. Verification of untaxed income (See Question 45 of the FAFSA for additional explanation). If an item does not apply, enter 0.
2013 Amount
Sources of Untaxed Income
2013 Amount
Sources of Untaxed Income
c. Tax Exempt Interest
$
a. Payments to tax deferred pension
$
(W-2 box 12 a-d codes D,E,F,G,H,S )
and/or IRA deductions/payments
b.Untaxed portions of pensions and/or
IRA distributions
$
d. Other – (Please describe)
$
2. Verification of additional financial information - If you did not file and are not required to file a 2013 Federal income tax return, list below your
employer(s) and any additional income received in 2013 (use the W-2 form or other earnings statements, if available).
Sources
Total 2013 Income
$
E. Parent(s)’ Income and Tax Information - Check only one box below.






My parent(s) utilized the DRT AND did not change any of the information that was transferred.
I will submit a correction to the FAFSA and utilize the DRT for my parent(s) by _________ (date). I realize that we should NOT change any of the
information that is transferred.
My parent(s) are unable or choose note to use the DRT, and instead will provide the school with a 2013 IRS Tax Return Transcript by __________.
My Parents filed separate returns and cannot use the DRT. 2013 IRS Tax Return Transcripts are provided for both parents
My Parents filed separate returns and cannot use the DRT. 2013 IRS Tax Return Transcripts will be provided by ________________________.
My parent(s) will not file, and are not required to file, a 2013 Federal Tax Return (See E2 below.)
1. Verification of untaxed income (See question 94 of the FAFSA for additional explanation) If an item does not apply enter 0.
Sources of Untaxed Income
2013 Amount
Sources of Untaxed Income
2013 Amount
a. Payments to tax deferred pension
$
c. Tax Exempt Interest
$
$
d. Other – (Please describe)
$
(W-2 box 12 a-d codes D,E,F,G,H,S)
and/or IRA Deductions/Payments
b. Untaxed portions of pensions and/or
IRA distributions
2. Verification of additional financial information - If your parent(s) did not file and are not required to file a 2013 Federal income tax return, list below
their employer(s) and any additional income they received in 2013 (use the W-2 form or other earnings statements, if available).
Sources
Total 2013 Income
$
F. Verification of Child Support Paid – (If you need more space use a separate page).
Name of Person who Paid Child
Support
Name of Person Who
Received Child
Support
Name of Child for Whom Support
was Paid
Amount of Child
Support Paid in
2013
$
$
G. Signatures
Each person signing this form certifies that all the information reported on it is complete and correct.
___________________________________________________________________________
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.
(V1, 5 and 6)

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