2016-2017
Verification Worksheet
(Group V6)
Student Name ______________________________________________________________
SCCC ID#__________________________________
Address_____________________________________________________ City ________________________________ State ________ ZIP___________
Home Phone Number (include area code) _______________________________________ Cell Phone Number_________________________________
Please check one:
 I am a Dependent Student [who needs to provide parental information]
 I am an Independent Student
FOR NJ RESIDENTS ONLY: Additional Questions required by NJHESAA to determine STATE Aid. (Enter N/A or -0- if not applicable)
Driver’s License - State Issued and Number:
Veterans Educational Benefits received between 7/1/16-6/30/17:
Amount per month: $
# of months:
2015 Untaxed Social Security Benefits:
Parent: $
Student: $
2015 Taxable Social Security Benefits:
Parent: $
Student: $
2015 Earned Income Credit on the tax return:
Parent: $
Student: $
2015 Unemployment received:
Parent: $
Student: $
Your application was selected for review in a process called “Verification”. Verification is a process governed by Federal and/or State regulations and is
used to ensure that the information applicants report on the Free Application for Federal Student Aid (FAFSA) is accurate. In this process, SCCC will
compare information from your 2016-17 FAFSA to the documents you provided. If there are differences, your FAFSA information may need to be
corrected. You and at least one parent (if Dependent) must complete and sign this worksheet and submit to the Financial Aid Office. Additional
information may be requested.
A. Student’s Family Information [For Dependent & Independent Students]
Dependent Student
List the people in your parent’s household. Include:

Yourself and your parent(s) (including a stepparent) even if you don’t 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, 2016, through June 30, 2017, or if
the other children would be required to provide parental information if they were completing a FAFSA for 2016–2017. 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 of their support and will continue to provide
more than half of their support through June 30, 2017.
Independent Student
List the people in your household. Include:

Yourself.

Your spouse, if you are married.

Your children, if any, if you will provide more than half of their support from July 1, 2016, through June 30, 2017, or if the child would be
required to provide your information if they were completing a FAFSA for 2016–2017. Include children who meet either of these standards,
even if they do not live with you.

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 through June 30, 2017.
Be sure to include the name of the college for any household member [Dependent Students exclude your parent(s)] who will be enrolled, at least
half time in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2016 and June 30, 2017.
If more space is needed, attach a separate page with the student’s name and SCCC ID# at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
self
SCCC
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NAME: ________________________________________________________________ SCCC ID#: __________________________
B. Student’s Income Information to Be Verified [For Dependent & Independent Students]
1. TAX RETURN FILERS
Instructions: Complete this section if the student and/or spouse, (if Independent), filed or will file a 2015 income tax return with
the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the student has
not already used the tool, go to www.FAFSA.gov, log in to the student’s FAFSA record, select “Make FAFSA Corrections,” and
navigate to the Student’s Financial Information section of the form. From there, follow the instructions to determine if the student
is eligible to use the IRS Data Retrieval Tool to transfer 2015 IRS income tax information into the student’s FAFSA. It takes up to
three weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to
eleven weeks for paper IRS tax return filers.
Check the box that applies:

The student has used the IRS Data Retrieval Tool on FAFSA to retrieve and transfer 2015 IRS income information into the
student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. The student’s school will use the IRS
information that was transferred in the verification process.

The student has not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to retrieve and
transfer 2015 IRS income information into the student’s FAFSA once the student has filed a 2015 IRS tax return. See
instructions above for information on how to use the IRS Data Retrieval Tool. The student’s school cannot complete the verification
process until the IRS information has been transferred into the FAFSA.

The student is unable or chooses not to use the IRS Data Retrieval Tool on the FAFSA, and the student is submitting to
the school a 2015 IRS Tax Return Transcript—not the Income Tax Return. To obtain an IRS tax return transcript, go to
www.IRS.gov and click on Tools, choose “Get Transcript of your Tax Records”, then “Get Transcript By Mail”.
2. TAX RETURN NON-FILERS
Instructions: Complete this section if the student and/or spouse is not required to file a 2015 Income Tax Return.
Check the box that applies:

The student was not employed and had no income earned from work in 2015.

The student was employed in 2015 and has listed below the names of all the employers, the amount earned from each
employer in 2015, and whether an IRS W-2 form is attached. Attach copies of all 2015 IRS W-2 forms issued to the
student by employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate
page with the student’s name and SCCC ID# at the top.
Employer’s Name
2015 Amount Earned
IRS W-2 Attached?
If you did not include copies of your W-2 Forms please explain why you have not included copies of some or all of your W-2’s.
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Revised 02/03/2016
NAME: ________________________________________________________________ SCCC ID#: __________________________
C.
Parent’s Income Information to Be Verified [For Dependent Students]
1. TAX RETURN FILERS
Instructions: Complete this section if the student’s parent(s) filed or will file a 2015 income tax return with the IRS. The best
way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If the parent has not already
used the tool, go to www.FAFSA.gov, login in to the student’s FAFSA record, select “Make FAFSA Corrections,” and navigate to
the Parent’s Financial Information section of the form. From there, follow the instructions to determine if the parent is eligible
to use the IRS Data Retrieval Tool to transfer 2015 IRS income tax information into the student’s FAFSA. It takes up to three
weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to
eleven weeks for paper IRS tax return filers.
Check the box that applies:

The student’s parent(s) has used the IRS Data Retrieval Tool on the FAFSA to transfer 2015 IRS income information into
the student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA. The student’s school will use
the IRS information transferred into the student’s FAFSA to complete the verification process.

The student’s parent(s) has not yet used the IRS Data Retrieval Tool, but will use the tool to transfer 2014 IRS income
information into the student’s FAFSA once the parent’s IRS tax return has been filed. See instructions above for
information on how to use the IRS Data Retrieval Tool. The student’s financial aid administrator cannot complete
verification until the parent has transferred IRS information into the student’s FAFSA.

The parent(s) is unable or chooses not to use the IRS Data Retrieval Tool, and the and the parent is submitting to the
school a 2015 IRS Tax Return Transcript—not the Income Tax Return. To obtain an IRS tax return transcript, go to
www.IRS.gov and click on Tools, choose “Get Transcript of your Tax Records”, then “Get Transcript By Mail”.
2. TAX RETURN NON-FILERS
Instructions: Complete this section if the student’s parent(s) will not file and is not required to file a 2015 income tax return
with the IRS.
Check the box that applies:

The parent(s) was not employed and had no income earned from work in 2015.

The parent(s) was employed in 2015 and has listed below the names of all the parent’s employers, the amount earned
from each employer in 2015, and whether an IRS W-2 form is attached. Attach copies of all 2015 IRS W-2 forms issued to
the parent(s) by employer(s). List every employer even if they did not issue an IRS W-2 form. If more space is needed,
attach a separate page with the student’s name and SCCC ID# at the top.
Employer’s Name
2015 Amount Earned
IRS W-2 Attached?
If you did not include copies of your W-2 Forms please explain why you have not included copies of some or all of your W-2’s.
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NAME: ________________________________________________________________ SCCC ID#: __________________________
D. OTHER UNTAXED INCOME/RESOURCES [For Dependent & Independent Students]
STUDENT/
SPOUSE
SOURCE & AMOUNTS OF 2015 UNTAXED INCOME (FOR THE YEAR).
IF NONE ENTER $0 OR N/A. DO NOT LEAVE BLANK.
Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings),
including, but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G,
H and S. Don’t include amounts reported in code DD.
Child support received for all children in the household. Do not include foster care or adoption payments.
PARENT(S)
Housing, food and other living allowances paid to members of the military, clergy and others (including cash
payments and cash value of benefits). Do not include the value of on-base military housing or the value of a
basic military allowance for housing.
Veterans’ non-education benefits, such as Disability, Death Pension, or Dependency & Indemnity
Compensation (DIC) and/or VA Educational Work-Study allowances.
Other untaxed income not reported in items 94a through 94h, such as workers’ compensation, disability, etc.
Also include the untaxed portions of health savings accounts from IRS Form 1040—line 25. Do not include
extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare
payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act
educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from
flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on
special fuels.
Untaxed Social Security benefits received
Public Assistance including housing (Section 8), Food Stamps (SNAP), TANF etc.
Money received, or paid on student’s/family’s behalf (e.g., bills), not reported elsewhere on this form. This
includes money that you received from a parent whose financial information is not reported on this form.
Other Untaxed Income (please specify source)
E.
Certification and Signatures
I/we certify that all of the information reported on this
worksheet is complete and correct.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
_________________________________________________
STUDENT SIGNATURE [FOR INDEPENDENT & DEPENDENT STUDENTS]
_________________________________
DATE
_________________________________________________
PARENT SIGNATURE [FOR DEPENDENT STUDENTS ONLY]
_________________________________
DATE
Do not mail this worksheet to the U.S. Department of Education or NJ Higher Education Student Assistance Authority (NJHESAA).
Submit this worksheet to the Financial Aid Office at Sussex County Community College.
You should make a copy of this worksheet for your records.
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Revised 02/03/2016