2023 Untaxed Income Verification

It takes a minimum of 5 to 10 days for all Verification forms and documentation to be reviewed.

Complete the information in the chart below with the amount of each 2023 Untaxed Income item as requested on the 2025-2026 FAFSA. If any item does not apply, write “0.” DO NOT Estimate the figure.

To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in 2023, multiply that amount by the number of months in 2023 you received it. If you did not receive the same amount each month in 2023, add together the amounts you paid or received each month.

Student Name(Required)

Student ID Number(Required)

2023 Untaxed Income – Parent(s) (Dependent Student Only)

Payments to Tax-deferred pension and retirement savings plans(Required)

List any payments (direct or withheld from earnings) to tax-deferred pensions and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H and S.

Annual Child support Received

List the actual amount of any child support received in 2023 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.

IRA deductions and payments to self-employed SEP, SIMPLE and Keogh and other qualified plans from IRS Form Schedule 1 total of lines 16 + 20

Tax exempt interest income from IRS Form 1040 – line 2a

Untaxed portions of IRA distributions form 1040: line 4a – 5a

Exclude rollovers. If negative, enter zero.

Untaxed portions of Pensions IRS form 1040: line 5a – 5b

Exclude rollovers. If negative, enter zero

Tax exempt interest income from IRS Form 1040 – line 2a

Untaxed portions of Pensions IRS form 1040: line 5a-5b

Education Credits (American Opportunity, Hope and Lifetime Learning Tax Credits) IRS Form Schedule 3 – line 3

Child support you PAID because of divorce or separation as the result of a legal requirement (only include amount paid in 2023)

Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships and assistantships

Taxable College grant and scholarship aid reported to the IRS in the adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments) as well as grant or scholarship portions of fellowships and assistantships

Earnings from work under a cooperative education program offered by a college

Student (and spouse, if married)

Payments to Tax-deferred pension and retirement savings plans(Required)

List any payments (direct or withheld from earnings) to tax-deferred pensions and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H and S.

Annual Child support Received(Required)

List the actual amount of any child support received in 2023 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.

IRA deductions and payments to self-employed SEP, SIMPLE and Keogh and other qualified plans from IRS Form Schedule 1 total of lines 16 + 20(Required)

Tax exempt interest income from IRS Form 1040 – line 2a(Required)

Untaxed portions of IRA distributions form 1040: line 4a – 5a(Required)

Exclude rollovers. If negative, enter zero.

Untaxed portions of Pensions IRS form 1040: line 5a-5b(Required)

Exclude rollovers. If negative, enter zero

Education Credits (American Opportunity, Hope and Lifetime Learning Tax Credits) IRS Form Schedule 3 – line 3(Required)

Child support you PAID because of divorce or separation as the result of a legal requirement (only include amount paid in 2023)(Required)

Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships and assistantships(Required)

Taxable College grant and scholarship aid reported to the IRS in the adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments) as well as grant or scholarship portions of fellowships and assistantships(Required)

Earnings from work under a cooperative education program offered by a college(Required)

Explanation, if needed:

Student Signature(Required)

Parent Signature (Dependent Student Only)