DVER-E (Department use only)

Your Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification (CFR Title 34, Part 668). In this process, Oregon State University will be comparing information from your FAFSA with financial documents. If there are differences between your FAFSA information and verification documents provided, the Office of Financial Aid may make corrections to your FAFSA using the information provided in the verification process. Any verification documents with missing or incomplete information cannot be processed and will result in delayed disbursements of financial aid funds.

A. Parent Marital StatusFor the parent(s) that completed the FAFSA, please indicate your marital status at the time of the original 2017-2018 FAFSA filing:

B. Household Size and Number in CollegeThe legal parent’s household should include: The student. The legal parent/stepparent(s). The legal parent/stepparent(s) children, if they will receive more than half of their support from the legal parent/stepparent(s)

from July 1, 2017, through June 30, 2018. Other dependents, if they now live with the legal parent/stepparent(s), and currently receive more than half of their support

from the legal parent/stepparent(s), and will continue to do so from July 1, 2017 through June 30, 2018.

Full name of family members in the household.

Start with student(s).

Relationship to Student

AgeName of the college for any family member

(excluding parents) who will be working toward a degree or certificate and will be enrolled at least ½ time during 2017-18 academic year.

1. Student Oregon State University 2.

3.

4.

5.

6. Additional household members can be included on a separate sheet of paper.

Total in Household ____________ Total in College ___________

Note: Both the student and parent(s) must complete this required verification document. Please submit all requested verification documentation for processing within 45 days of initial request.

2017-2018 Dependent Student Verification Worksheet

__________________________________________________________________________________________ Student Name Student ID#

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Married

Remarried (include stepparent's information)

Separated and living in separate residences

Divorced

Widowed

Legal parents unmarried and living together

Never married

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C. Parent(s) Tax Forms and Income Information

CHECK ONE:

IF YOU: PARENT(S) MUST:

USED the IRS Data Retrieval Tool to transfer 2015 tax data to the FAFSA

Complete this Verification Worksheet and return it to our office. (You DO NOT NEED to provide a copy of your IRS Tax Return at this time.)☐

DID NOT (or could not) transfer your 2015 income information to the FAFSA using the IRS Data Retrieval Tool.

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DID NOT work and WILL NOT file a 2015 Federal Tax Return.

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Filed a foreign return or had foreign income

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WORKED, but NOT REQUIRED TO FILE a 2015 Federal Tax Return. Parent(s) Employer Name 2015

Earnings

W-2/1099-MiscIssued?

Y/N $ Yes☐ No☐ $ Yes☐ No☐ $ Yes☐ No☐ $ Yes☐ No☐

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You are a victim of IRS tax-related identity theft and cannot get a tax transcript or use the FAFSA Data Retrieval Tool (DRT)

1. Call the IRS Identity Protection Specialized Unit at 800-908-4490 to request a “TaxReturn Data Base View" (TRDBV) to submit for verification; and

2. Sign and date the statement below indicating you were a victim of IRS tax-related identitytheft and the IRS is aware of the tax-related identity theft.

"I affirm that I was a victim of IRS tax-related identity theft and the IRS is aware of thetax-related identity theft."

___________________________________________________________________________ Signature Date

Filed an Amended 2015 Federal Tax Return

Submit a copy of your signed original 2015 IRS Tax Return form as well as a signed copy of your Amended Federal Tax Return (IRS 1040-X) even if you used the IRS Data Retrieval Tool.

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Rollover or Distribution If there is a dollar amount on your 2015 Federal Tax Return for IRA Distributions (1040-Line 15a, 1040A-Line 11a) or Pensions and Annuities (1040-Line 16a, 1040A-Line 12a) this may be from an untaxed IRA, pension or annuity. Please indicate whether these funds resulted from a rollover, distribution or life insurance policy. If you are unsure if it was a rollover, please contact your tax preparer. Additional documentation may be required (see below).

☐ The IRA, pension or annuity WAS a “rollover”. Provide a copy of your 2015 1099-R(s).☐ The IRA, pension or annuity WAS NOT a “rollover”. ☐ The amount was from a life insurance policy. ☐ There is no amount on these lines.

Complete this Verification Worksheet and return it to our office, and 1. Provide copies of each 2015 W-2/1099 Misc for each source of employment income2. Complete the next section clarifying your 2015 income/earnings. Do not leave this

blank.

DVER-E (Department use only)

Student Name Student ID#

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Visit our website to view our Verification FAQ's!

1. Complete this Verification Worksheet and return it to our office, and2. Provide an original, as well as an English translation of the foreign financial documents.*If you filed a tax return with Guam, the Commonwealth of the Northern Mariana Islands or Puerto Rico, American Samoa, or the U.S. Virgin Islands, provide a signed copy of that tax return filed with the relevant tax authority.*

1. Complete this Verification Worksheet and return it to our office, and2. Attach a signed copy of your 2015 IRS Tax Return form (1040, 1040A, or 1040EZ)Note: If you and your spouse filed your taxes separately each person will need to submit a

copy of their signed 2015 IRS Tax Return form.

Please sign here affirming you did not work and will not file a 2015 Federal Tax Return: _______________________________________________________________________ Signature Date

E. SignatureBy signing this worksheet, I certify that all the information reported is complete and correct. I understand I may loseconsideration for limited funds if I do not submit ALL verification documents in a timely manner.

Please sign this form in ink. We are unable to accept e-signed documents.

D. Student Tax Forms and Income Information

CHECK ONE:

IF YOU: STUDENT MUST:

USED the IRS Data Retrieval Tool to transfer 2015 tax data to the FAFSA

1. Complete this Verification Worksheet and return it to our office.(You DO NOT NEED to provide a copy of your IRS Tax Return at this time.)☐

DID NOT (or could not) transfer your 2015 income information to the FAFSA using the IRS Data Retrieval Tool.

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DID NOT work and WILL NOT file a 2015 Federal Tax Return.

Please sign here affirming you did not work and will not file a 2015 Federal Tax Return: _______________________________________________________________________ Signature Date

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Filed a foreign return or had foreign income

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WORKED, but NOT REQUIRED TO FILE a 2015 Federal Tax Return. Student Employer Name 2015

Earnings

W-2/1099-MiscIssued?

Y/N $ Yes☐ No☐ $ Yes☐ No☐ $ Yes☐ No☐ $ Yes☐ No☐

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You are a victim of IRS tax-related identity theft and cannot get a tax transcript or use the FAFSA Data Retrieval Tool (DRT)

1. Call the IRS Identity Protection Specialized Unit at 800-908-4490 to request a “TaxReturn Data Base View" (TRDBV) to submit for verification; and

2. Sign and date the statement below indicating you were a victim of IRS tax-related identitytheft and the IRS is aware of the tax-related identity theft.

"I affirm that I was a victim of IRS tax-related identity theft and the IRS is aware ofthe tax-related identity theft."

___________________________________________________________________________ Signature Date

Filed an Amended 2015 Federal Tax Return

Submit a copy of your signed original 2015 IRS Tax Return form as well as a signed copy of your Amended Federal Tax Return (IRS 1040-X) even if you used the IRS Data Retrieval Tool.

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Complete this Verification Worksheet and return it to our office, and 1. Provide copies of each 2015 W-2/1099 Misc for each source of employment income2. Complete the next section clarifying your 2015 income/earnings. Do not leave this blank.

DVER-E (Department use only)

_________________________________________________________________________________________________________ Parent Signature Date

_________________________________________________________________________________________________________ Student Signature Date

Student Name Student ID#

Page 3 of 3

1. Complete this Verification Worksheet and return it to our office, and2. Provide an original, as well as an English translation of the foreign financial documents.*If you filed a tax return with Guam, the Commonwealth of the Northern Mariana Islands or Puerto Rico, American Samoa, or the U.S. Virgin Islands, provide a signed copy of that tax return filed with the relevant tax authority.*

1. Complete this Verification Worksheet and return it to our office, and2. Attach a signed copy of your 2015 IRS Tax Return form (1040, 1040A, or 1040EZ)