Hudson County Community College
Office of Student Financial Assistance
70 Sip Avenue Jersey City, NJ 07306
Tel No. (201)360-4200 Email: [email protected]
2017-2018 Number of Household and Number in College Worksheet
Dependent Student
Your 2017-2018 Free Application for Federal Student Aid (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 and your parents
reported on your FAFSA. To verify that you provided correct information the financial aid administrator at HCCC 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.
A. Dependent Student’s Information
______________________________________________________________
Student’s Last Name
Student’s First Name
Student’s M.I.
___________________________________
Student’s Social Security Number
B. Dependent Student’s Family Information
List below 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, 2017, through
June 30, 2018, or if the other children would be required to provide parental information if they were completing a
FAFSA for 2017-2018. 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, 2018.
Include in the space below information about any household member who is, or will be, enrolled at least half time in a
degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2017, and June
30, 2018, include the name of the college. If more space is needed, attach a separate page with the student’s name and Social
Security Number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Missy Jones (example)
18
Wife
Hudson County Community College
Yes
Self
C. Tax Filers Must Provide IRS Tax Information. (1) If you did not retrieve and transfer your and /or your parent(s)
income tax return information using the IRS Data Retrieval Process when initially completing the FAFSA on the Web, you can
make corrections using FAFSA on the Web to subsequently transfer this information. (2) If you did not utilize the IRS Data
Retrieval process, you must submit a copy of your 2015 FEDERAL TAX RETURN TRANSCRIPT. Copies of tax returns (IRS 1040,
1040A, 1040EZ) will no longer be accepted with the exception of tax returns from Puerto Rico or foreign income tax returns.
To request a copy of your 2015 FEDERAL TAX RETURN TRANSCRIPT from the IRS, call (800)908-9946 or go to www.IRS.gov. If
you amended your tax return after you filed, you must also provide a copy of the 2015 FEDERAL TAX ACCOUNT TRANSCRIPT.
Check the box that applies:
The parents have used the IRS DRT in FAFSA on the Web to transfer 2015 IRS income tax return information into the
student’s FAFSA.
The parents has not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2015 IRS income tax return
information into the student’s FAFSA once the 2014 IRS income tax return has been filed.
The parent is unable or chooses not to use the IRS DRT in FAFSA on the Web, and instead will provide the school a 2015 IRS Tax
Return Transcript(s).
D. Dependent Student’s NON-TAX FILERS Income information to Be Verified
TAX RETURN NONFILERS—Complete this section if you, the student (and, if married, your spouse), will not file and are not
required to file a 2015 income tax return with the IRS.
Check the box that applies:
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2014.
The student (and/or the student’s spouse if married) was employed in 2015 and has listed below the names of all
employers, the amount earned from each employer in 2015, and whether an IRS W-2 form is attached. Attach copies of
all 2015 W-2 forms issued to you (and, if married, to your spouse) by employers. If more space is needed, attach a
separate page with your name and SSN at the top.
Note: We may require you to provide documentation from the IRS that indicates a 2015 IRS income tax return was not
filed with the IRS.
Employer’s Name
Suzy’s Auto Body Shop (example)
2015 Amount Earned
$2,000.00(example)
IRS W-2 Attached?
Yes(example)
E. Parent’s NON-TAX FILERS Income Information to Be Verified
TAX RETURN NONFILERS— 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 Social Security Number at the top.
Note: We may require you to provide documentation from the IRS that indicates a 2015 IRS income tax return was not
filed with the IRS.
Employer’s Name
2015 Amount Earned
IRS W-2 Attached?
Suzy’s Auto Body Shop (example)
$2,000.00 (example)
Yes (example)
F. Certification and Signatures
Each person signing this worksheet certifies that all of the
Information reported is complete and correct. The student
and one parent whose information was reported on the FAFSA
must sign and date.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
_________________________________________________
Print Student’s Name
_________________________________
Student’s ID Number
_________________________________________________
Student’s Signature
_________________________________
Date
______________________________________________
Parent’s Signature
__________________________________
Date