Dependent Verification Worksheet



Dependent Verification Worksheet
CSU LA SealCenter for Student Financial Aid
California State University, Los Angeles
5151 State University Drive, SA 124
Los Angeles, CA 90032-8402
Phone: (323) 343-6260
Fax: (323) 343-3166 		2012-2013
DEP_VER � 02/12
For Office Use Only
2012-2013 Dependent Verification Worksheet

Your application was selected for review in a process called �Verification.� The Financial Aid Office will compare your Free Application for Federal Student Aid (FAFSA) with the information on this worksheet and any other required documents. If there are any differences, your FAFSA information may need to be corrected. Please keep in mind that incomplete forms will create a delay in processing.

Instructions:
  • You and at least one parent must complete and sign this worksheet.
  • Submit the worksheet and any required documents to the Center for Student Financial Aid.
A. Student Information
New Section
First Name Last Name Middle Initial

Address (include apt. no.)
City State ZIP Code



CIN
Date of Birth
Phone Number (include Area Code)
B. Dependent Student�s Family Information
New Section

List the people in your parent(s) household. Include:
  • Yourself and your parent(s) (including a stepparent) even if you do not live with your parent(s).
  • Your parent(s)� other children if your parent(s) will provide more than half of their support from July 1, 2012 through June 30, 2013; OR, if the other children would be required to provide parental 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 your parent(s).
  • Other people if they now live with your parent(s) and your parent(s) provide more than half or their support and will continue to provide more than half of their support through June 30, 2013.
Include the names all household members that meet the definition above in the space(s) below. Also, include the name of the college for any household member (excluding your parents) who will be enrolled at least half-time (6 units) in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2012 and June 30, 2013. Attach a separate page if needed.
Full Name Age Relationship College Will be Enrolled at
Least Half-Time
Martha Jones (example) 24 Sister California State University, Los Angeles Yes
Self


C. Student�s Income Information to be verified
New Section
  1. TAX RETURN FILERS
    Complete this section if you filed or will file a 2011Federal Income Tax Return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of the FAFSA on the web www.fafsa.gov. It takes up to 2-weeks for IRS income information to be available for electronic tax filers and up to 8-weeks for paper IRS tax return filers.

    Check the box that applies:
    Check here if you have used the IRS Data Retrieval Tool in the FAFSA on the Web to retrieve and transfer your 2011 IRS income information onto your FAFSA. The Financial Aid Office will use the transferred information for the verification process.
    Check here if you are unable to (OR) choose not to use the IRS Data Retrieval Tool in the FAFSA on the Web and you are submitting a 2011 IRS Tax Return Transcript with this worksheet.
    • To obtain an IRS tax return transcript visit www.IRS.gov and select the �order a Return or Account Transcript� link. Or call 1 (800) 908-9946. Be sure to request the �IRS Tax Return transcript� and not the �IRS Tax Account transcript.�
  2. AMENDED TAX RETURN FILERS:
    Select this box if you changed or corrected your federal income tax return originally filed with the IRS. If yes, you must submit both items below:
    • IRS �Tax Return� Transcript (AND)
    • IRS Tax �Account� Transcript
  3. NON-TAX FILERS
    Complete this section if you will not file and were not required to file a 2011 income tax return with the IRS. Check the box that applies:
    Check here if you were not employed and had no income from work during 2011.
    Check here if you were employed in 2011 and list below the name of all employers and the amount earned from work from each employer. Attach all copies of W-2 forms issued by your employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attached a separate page.
Employer's Name 2011 Amount Earned IRS W-2 Attached?
Suzy�s Auto Body Shop (example) $2,000.00 (example) Yes (example)


D. Parent�s Income Information to be verified � Note: If two parents were reported in Section B of this worksheet, the     instructions and certifications below refer and apply to both parents.

New Section
  1. TAX RETURN FILERS
    Complete this section if you filed or will file a 2011Federal Income Tax Return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of the FAFSA on the web www.fafsa.gov. It takes up to 2-weeks for IRS income information to be available for electronic tax filers and up to 8-weeks for paper IRS tax return filers.

    Check the box that applies:
    Check here if you have used the IRS Data Retrieval Tool in the FAFSA on the Web to retrieve and transfer your 2011 IRS income information onto your FAFSA. The Financial Aid Office will use the transferred information for the verification process.
    Check here if you are unable to (OR) choose not to use the IRS Data Retrieval Tool in the FAFSA on the Web and you are submitting a 2011 IRS Tax Return Transcript with this worksheet.
    • To obtain an IRS tax return transcript visit www.IRS.gov and select the �order a Return or Account Transcript� link. Or call 1 (800) 908-9946. Be sure to request the �IRS Tax Return transcript� and not the �IRS Tax Account transcript.�
  2. AMENDED TAX RETURN FILERS:
    Select this box if you changed or corrected your federal income tax return originally filed with the IRS. If yes, you must submit both items below:
    • IRS �Tax Return� Transcript (AND)
    • IRS Tax �Account� Transcript
  3. NON-TAX FILERS
    Complete this section if you will not file and were not required to file a 2011 income tax return with the IRS. Check the box that applies:
    Check here if you were not employed and had no income from work during 2011.
    Check here if you were employed in 2011 and list below the name of all employers and the amount earned from work from each employer. Attach all copies of W-2 forms issued by your employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attached a separate page.
Employer's Name 2011 Amount Earned IRS W-2 Attached?
Suzy�s Auto Body Shop (example) $2,000.00 (example) Yes (example)


E. Please Sign and Date Below
New Section

By signing this worksheet, we certify that all the information reported on this worksheet is complete and correct. The student and one parent must sign and date.
Student's Date
Parent's Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.