1845-0041 Verification worksheet (This is an optional form.)

Independent

2007-2008 Verification Worksheet
U.S. Department
of Education

Federal Student Aid Programs

Your application was selected for review in a process called
“Verification.” In this process, your school will be comparing
information from your application with signed copies of your
(and your spouse’s, if you are married) 2006 Federal tax forms,
or with W-2 forms or other financial documents. The law says
we have the right to ask you for this information before awarding
Federal aid. If there are differences between your application information and your financial documents, you or your school may
need to make corrections electronically or by using your Student
Aid Report (SAR).
Complete this verification form and submit it to your financial
aid administrator as soon as possible, so that your financial aid
won’t be delayed. Your financial aid administrator will help you.

1.

2.

3.
4.

5.

FORM APPROVED
OMB NO. 1845-0041

What you should do

Collect your (and your spouse’s) financial documents (signed
Federal income tax forms, W-2 forms, etc.).
Talk to your financial aid administrator if you have questions
about completing this worksheet.
Complete and sign the worksheet.
Submit the completed worksheet, tax forms, and any other
documents your school requests to your financial aid
administrator.
Your financial aid administrator will compare information on
this worksheet and any supporting documents with the
information you submitted on your application. You may
need to make corrections electronically or by using your SAR.
Your school must review the requested information, under the
financial aid program rules (34 CFR, Part 668).

A. Student Information
Last name

First name

Social Security Number

M.I.

Date of birth

Address (include apt. no.)
City

State

ZIP code

Phone number (include area code)

B. Family Information
List the people in your household, include:
• yourself, and your spouse if you have one, and
• your children, if you will provide more than half of their support from July 1, 2007 through June 30, 2008, and
• other people if they now live with you, and you provide more than half of their support and will continue to provide more than half
of their support from July 1, 2007 through June 30, 2008.

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 college at least half time between July 1, 2007 and June 30, 2008, and will be enrolled
in a degree, diploma, or certificate program. If you need more space, attach a separate page.
Full Name

Martha Jones (example)

Age

24

Relationship

Wife

College

City University

Self

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 1845-0041. The time required to complete this information collection is estimated to average twelve minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: US Department of Education, Washington, DC 20202-5345.

Independent

C. Student’s Tax Forms and Income Information (all applicants)

1. Check only one of the boxes below. Tax returns include the 2006 IRS Form 1040, 1040A, 1040EZ, a tax return from
Puerto Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax
preparer or request an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Check here if you will not file and are not required to file a 2006 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Worksheets A & B of the Free Application for Federal Student
Aid-(FAFSA))
Sources of Untaxed Income
a. Child Support
b. Social Security (non-taxed)
c. Welfare (including TANF)

2006 Amount

Sources of Untaxed Income
d.
e.

$
$
$

2006 Amount

$
$
$

f.

3. If you did not file and are not required to file a 2006 Federal income tax return, list below your employer(s) and any
income received in 2006 (use the W-2 form or other earnings statements if available).
Sources

2006 Amount

$
$
$
D. Spouse’s Tax Forms and Income Information (if student is married)
1. Check only one box below. Tax returns include the 2006 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico
or a foreign income tax return. If your spouse did not keep a copy of the tax return, request a copy from the tax preparer
or request an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your spouse’s tax return.
Check here and attach spouse’s signed tax return if your spouse filed a separate return.
Check here if a signed spouse’s tax return will be submitted to the school by ______________________(date).
Check here if your spouse will not file and is not required to file a 2006 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Worksheets A & B of the FAFSA)
Sources of Untaxed Income
a. Child Support
b. Social Security (non-taxed)
c. Welfare (including TANF)

2006 Amount

Sources of Untaxed Income
d.
e.

$
$
$

2006 Amount

$
$
$ 

f.

3. If your spouse did not file and is not required to file a 2006 Federal income tax return, list below your spouse’s
employer(s) and any income received in 2006 (use the W-2 form or other earnings statements if available).
Sources

2006 Amount

$
$
$
E. Sign this Worksheet
By signing this worksheet, I (we) certify that all the information
reported on it is complete and correct. If married, spouse’s signature
is optional.

Student

Date

Spouse

Date

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

Do not mail this worksheet to the Department of Education. Submit this worksheet to your
Financial Aid Administrator at your school. Don’t forget to sign your tax forms.