Verification of Other Untaxed Income

Verification of Other Untaxed Income

2015-2016

Your application was selected for review in a process called “Verification”. In this process we will be comparing information you submitted on your FAFSA with your financial documents and information of other untaxed income. We may need to make corrections electronically to your application.

Student Name

Student ID: P000

Instructions:

1. If any item does not apply, enter “N/A” for Not Applicable.

2. If you (the student) were required to provide parental information on the FAFSA, answer each question below as it applies to the student and the student’s parent whose information is on the FAFSA.

3. If you (the student) were not required to provide parental information on the FAFSA, answer each question as it applied to you and to your spouse (if married).

A. Other Untaxed Income

 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 veteran’s education benefits, military house, SNAP, TANF, etc.

 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 in section A or B above. In addition do not include student aid, 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.

Name of Recipient / Type of Benefit Received / Amount Received 2014
/ / $
/ / $
/ / $

B. Money received or paid on the student’s behalf

 List any money received or paid on the student’s behalf (for example: payment of student’s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received in 2014.

 Include support from a parent or other adult whose information was not reported on the FAFSA.

Ø  Example: payment of rent, utility bills, or food for the student

 If you lived with someone other than a parent (such as a grandparent or legal guardian) you must list the amount of financial support provided for you (the student) in 2014.

Ø To determine the value of the support received, you should consider monthly expenses paid by the person(s) you live with (such as rent/mortgage, utilities, food, cable, phone, internet service, entertainment, clothing, insurance etc.). Total these expenses and divide the total by the number of people living in the household to determine the value of the support provided to you on a monthly basis. Multiply that number by the number of months that you lived in the household in 2014.

 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

 Do not include support from a parent whose information was reported on the FAFSA

Purpose (ex. rent, bills, food, etc.) / Amount Received in 2014 / Source
/ / $
/ / $
/ / $

C. Child Support Received

 List the actual amount of any child support received in 2014 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.

Name of Adult Who Received the Support / Name of Child Support was Received / Amount Received 2014
/ / $
/ / $
/ / $

D. Veterans non-education benefits

 List the total amount of veterans non-education benefit received in 2014. Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances.

 Do not include federal veteran’s educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits or Post 9/11 GI Bill.

Name of Recipient / Type of Veterans
Non-education Benefit / Amount Received 2014
/ / $
/ / $
/ / $

E. Housing, food, and other living allowances paid to members of the military, clergy others

 Include cash payments and/or the cash value of benefits received in 2014.

 Do not include the value of on-base military housing or the value of a basic military allowance for housing

Name of Recipient / Type of Benefit Received / Amount Received 2014
/ / $
/ / $
/ / $

F. Certification and Signatures

Each person signing this form certifies that all the information reported on it is complete and correct.

______

Student Print Name/Student ID # Student’s Signature Date

______

Parent/Spouse (if applicable) Print Name Parent/Spouse Signature Date

AU · Student Financial Services · 420 West Main Street, Danville, VA 24541 · 1-800-AVERETT ·