Financial Aid Verification Worksheet

Your 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, we 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.

If additional documents must be sent to the Financial Aid Office, please use any of the following methods unless otherwise directed:

Mail: ATTN: Financial Aid Office
Appalachian Bible College
161 College Dr.
Mount Hope, WV 25880

Fax: 304-877-5082

Email: Scanned documents may be sent to: financialaid@abc.edu

(Please, ensure that all scanned documents include entire page and can be clearly read.)

Academic Year*

Select the academic year in which you are applying for financial aid.

First Name*

Last Name*

Date of Birth*

Date

Social Security Number

Phone Number

E-mail*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Number of Household Members Includes:

* The student AND

* The student’s spouse, if the student is married AND

* The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July 1, {currentYear}, through June 30, {nextYear}, even if the children do not live with the student AND

* Other people, if they now live with the student, and the student or spouse provides more than half of the other people’s support and will continue to provide more than half of their support through June 30, {nextYear}.

College Information: You only need to include college information about any household member, who will be enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, {currentYear}, and June 30, {nextYear}, include the name of the college if this applies.

Total Number in Household (including self)

List each person in your household, including the student.

Important Note: The instructions below apply to the student and spouse, if the student is married. Notify the Financial Aid Office if the student or spouse filed separate IRS income tax returns for {priorPriorYear} or had a change in marital status after December 31, {priorPriorYear}.

Have you or will you (the student) be required to file a {priorPriorYear} U.S. federal income tax return?*

The best way to verify income is by using the IRS Data Retrieval Tool (IRS DRT) that is part of FAFSA on the Web at FAFSA.gov. In most cases, no further documentation is needed to verify {priorPriorYear} income information that was transferred into the student’s FAFSA using the IRS DRT if that information was not changed by the FAFSA filer.

How has or will the student provide their {priorPriorYear} federal income tax return information?

The student HAS USED the IRS DRT in their FAFSA on the Web to transfer their IRS income tax return information for the studentThe student HAS NOT YET USED the IRS DRT in their FAFSA on the Web, but will use the tool to transfer their IRS income tax return information for the studentThe student is UNABLE or CHOOSES NOT TO USE the IRS DRT in their FAFSA on the Web, and instead will provide the school their IRS Tax Return Transcript(s) for the year listed above.

To request a tax return transcript go to: http://www.irs.gov/Individuals/Get-Transcript After receiving the transcript, please send a copy via one of the methods listed at the top of this form.

As a Nontax Filer, the student is required to provide documentation from the IRS or other relevant tax authority dated on or after October 1, {priorYear} that indicates a {priorPriorYear} IRS income tax return was not filed with the IRS or other relevant tax authority.

If the student has filed a tax return in another year, the student can request a tax return transcript online at: http://www.irs.gov/Individuals/Get-Transcript and select "Verification of Non-filing Letter" for {priorPriorYear}.

If the student has never filed a tax return, the student must use the paper request form – IRS Form 4506-T. Complete and submit the form to the IRS as instructed with the following guidelines:

Line 5 You may choose to send the report directly to ABC's address (ATTN: Financial Aid, 161 College Drive, Mt Hope, WV 25880)
Line 6 Enter "1040"
Line 7 Check the box for "Verification of Nonfiling"
Line 9 Enter 12/31/{priorPriorYear}

Once verification is received, send a signed copy to the Financial Aid Office using one of the methods listed at the top of this form.

Note: If the spouse filed a separate {priorPriorYear} IRS income tax return, {priorPriorYear} IRS Tax Return Transcripts must be provided for both student & spouse.

Upload {priorPriorYear} IRS Tax Return Transcript(s) (if currently available). This is a Transcript of your taxes received by the IRS

Select File

List below the names of all employers, the amount earned from each employer in {priorPriorYear} , and whether an IRS W-2 form is provided. List every employer even if the employer did not issue an IRS W-2 form. Example: Suzy's Auto Body Shop, $2,000.00, W-2 Provided

Upload W-2(s) (if currently available, otherwise copies must be sent via one of the methods listed at the top of this form)

Select File

Did you or your spouse (if married) receive untaxed income in {priorPriorYear}?*

Untaxed income may include: Tax-deferred pension & retirement savings; Child Support; Housing, Food, and other Living Allowances; Veterans Non-Education Benefits; Worker"s Comp., etc.

To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in {priorPriorYear}, multiply that amount by the number of months in {priorPriorYear} you paid or received it. If you did not pay or receive the same amount each month in {priorPriorYear}, add together the amounts you paid or received each month. Enter "N/A" for any category that does not apply.

A. Payments to tax-deferred pension and retirement savings - List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S. Name of Person Who Made the Payment, Total Amount Paid in {priorPriorYear}

B. Child support received - List the actual amount of any child support received in {priorPriorYear} for the children in your household. Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid. List the Following: Name of Adult Who Received the Support, Name of Child For Whom Support Was Received, Amount of Child Support Received in {priorPriorYear}

C. Housing, food, and other living allowances paid to members of the military, clergy, and others - Include cash payments and/or the cash value of benefits received. Do not include the value of on-base military housing or the value of a basic military allowance for housing. List the Following: Name of Recipient, Type of Benefit Received, Amount of Benefit Received in {priorPriorYear}

D. Veterans non-education benefits - List the total amount of veterans non-education benefits received in {priorPriorYear}. Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. Do not include federal veterans educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill. List the Following: Name of Recipient, Type of Veterans Non-educational Benefit, Amount of Benefit Received in {priorPriorYear}

E. Other untaxed income - List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers’ compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc. Do not include any items reported or excluded in A – D above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels. List the Following: Name of Recipient, Type of Other Untaxed Income, Amount of Benefit Received in {priorPriorYear}

F. Money received or paid on the student’s behalf - List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received in {priorPriorYear}. Include support from a parent whose information was not reported on the student’s {currentYear}–{nextYear} FAFSA, but do not include support from a parent whose information was reported. For example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person"s contributions unless the person is the student’s parent whose information is reported on the student’s {currentYear}–{nextYear} FAFSA. Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student’s parents , such as grandparents, aunts, and uncles of the student. List the Following: Purpose: (e.g., Cash, Rent, Books), Amount Received in {priorPriorYear}, Source

Additional Information: So that we can fully understand the student’s family's financial situation, please provide below information about any other resources, benefits, and other amounts received by the student and any members of the student’s household. This may include items that were not required to be reported on the FAFSA or other forms submitted to the Financial Aid Office, and include such things as federal veterans education benefits, military housing, SNAP, TANF, etc. List the Following: Name of Recipient, Type of Financial Support, Amount of Financial Support Received in {priorPriorYear}

Check any of the following that apply to your {priorPriorYear} Income Tax Return:

Granted a Filing Extension by the IRS

true

An individual who is required to file a {priorPriorYear} IRS income tax return and has been granted a filing extension by the IRS, must provide:

* A copy of IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual Income Tax Return,’’ that was filed with the IRS for tax year {priorPriorYear};
* A copy of the IRS's approval of an extension beyond the automatic six-month extension if the individual requested an additional extension of the filing time for tax year {priorPriorYear}; and
* A copy of IRS Form W–2 for each source of employment income received for tax year {priorPriorYear} and, if self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the U.S. income tax paid for tax year {priorPriorYear}.

Filed an Amended IRS Income Tax Return

true

An individual who filed an amended IRS income tax return for tax year {priorPriorYear} must provide:

* A {priorPriorYear} IRS Tax Return Transcript (that will only include information from the original tax return and does not have to be signed), or any other IRS tax transcript(s) that includes all of the income and tax information required to be verified; and
* A signed copy of the {priorPriorYear} IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that was filed with the IRS.

Victim of IRS Identity Theft

true

An individual who was the victim of IRS tax-related identity theft must provide:

* A Tax Return DataBase View (TRDBV) transcript obtained from the IRS, or any other IRS tax transcript(s) that includes all of the income and tax information required to be verified; and
* A statement signed and dated by the tax filer indicating that he or she was a victim of IRS tax-related identity theft and that the IRS is aware of the tax-related identity theft.

File Non-IRS Income Tax Returns

true

An individual who filed or will file a {priorPriorYear} income tax return with the relevant taxing authority of a U.S. territory, commonwealth, or with a foreign central government must provide:

* A transcript that was obtained at no cost from the relevant taxing authority of a U.S. territory (Guam, American Samoa, the U.S. Virgin Islands) or commonwealth (Puerto Rico and the Northern Mariana Islands), or a foreign central government, that includes all of the tax filer’s income and tax information required to be verified for tax year {priorPriorYear}; or
* If a transcript can not be obtained at no cost from the relevant taxing authority, a signed copy of the {priorPriorYear} income tax return(s).

If any additional required documents were listed above and you have electronic copies of these documents, you may upload them here. You may also use any of the methods listed at the top of this form to submit additional documents.

File Upload

Upload a File

Each person signing below certifies that all of the information reported is complete and correct.

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

Student Signature (type full name)*

Student Last 4 of SSN

Spouse's Signature (optional, type full name)

Spouse's Last 4 of SSN (optional)

Current Year

Prior Year

Prior Prior Year

Next Year

Financial Aid Verification Worksheet (Independent Student)

STUDENT INFO

HOUSEHOLD INFORMATION

STUDENT INCOME

HOUSEHOLD INCOME

UNUSUAL CIRCUMSTANCES

UPLOAD ADDITIONAL DOCUMENTS

SIGNATURE