Fairfield University - Office of Financial Aid - 2026–2027 Verification of Untaxed Income Form (for 2024)

Oct 22, 2026

Uploaded by Putri

Fairfield University Office of Financial Aid provides a verification worksheet used to document untaxed income details for financial aid eligibility. It instructs students to complete identifying information, determine whether the student is dependent or independent for parental questions, and calculate annual amounts based on 2024 payment patterns. The form includes sections for federal benefits received and specific categories of untaxed income, plus an additional information narrative, certification signatures, and submission contact details.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Section 1: Federal Benefits Received

Federal benefits checklist for 2024 or 2025

Section 2: Untaxed Income Section

Untaxed income categories (1–15)

Certifications and Signatures

Fairfield University Office of Financial Aid 2026–2027 Verification of Untaxed Income Form (for 2024) Student’s Last Name Student’s First Name Student’s Street Address (include Apt. \#) Student’s ID Number - - Student’s Phone Number City State Zip Code Student’s Email Address If the student was REQUIRED to provide parental information on the FAFSA (dependent student), answer each question on this worksheet as it applies to the student’s parent(s) whose information is on the FAFSA. If the student was NOT REQUIRED to provide parental information on the FAFSA (independent student), answer each question on this worksheet as it applies to the student (and the student’s spouse, if married) whose information is on the FAFSA. To determine the correct annual amount for each item: If you paid or received the same dollar amount every month in 2024, multiply that amount by the number of months in 2024 you paid or received it. If you did not pay or receive the same amount each month in 2024, add together the amounts you paid or received each month. Do not leave blanks. Put N/A if a particular item does not apply. Section 1: Federal Benefits Received Please check the appropriate box(es) if the independent student/spouse or dependent student’s parent(s) received any of the following federal benefits in 2024 or 2025: Medicaid or SSI (Supplemental Security Income) Supplemental Nutrition Assistance Program (SNAP) or Food Stamps Free or Reduced School Lunch Benefits (only if you meet the Department of Agriculture income guidelines) Temporary Assistance for Needy Families (TANF) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Earned Income Credit (EIC) Federal Housing Assistance Refundable Credit for Coverage Under a Qualified Health Plan (QHP) Section 2: Untaxed Income Section 1) Tax Exempt Medicaid Payments for In Home Support Services. Medicaid Waiver payments may be reported on Form W2, box 12 code II. a. Amount: Person Receiving the Benefit(s): 2) Untaxed IRA or Pension Distributions: a. Amount: Person Receiving the Benefit(s): i. State if it was an IRA or Pension Distribution: 3) Tax Exempt Interest Income: a. Amount: Person Receiving the Benefit(s): 4) IRA Deductions and Payments to Self-Employed SEP, SIMPLE, and qualified plans: a. Amount: Person Receiving the Benefit(s): 5) Housing, food, and other living allowances paid to members of the military, clergy, and others in 2024. Include cash payments and/or the cash value of benefits being received. Do not include the value of on-based military housing or the value of a basic military allowance for housing. a. Amount: Person Receiving the Benefit(s): 6) Veteran’s Non-Education Benefits in 2024. Include disability, death pension, dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. Do not include federal veteran’s educational benefits such as the Montgomery GI Bill, Post 9/11 GI Bill, Dependents Education Assistance Program, VEAP Benefits, etc. a. Amount: Type of Benefit: i. Person(s) Receiving Benefit: 7) Worker’s Compensation: a. Parent Amount: Person(s): 8) Untaxed Alimony: a. Amount: Person(s) Receiving Benefit: 9) Disability: a. Amount: Person(s) Receiving Benefit: 10) Combat Pay: a. Amount: Person(s): 11) Black Lung/Railroad Retirement Benefits: a. Amount: Type: Person(s): 12) Health Savings Account: a. Amount: Person(s): 13) Family Support Income in 2024. Please indicate if the parent or student received any monies from relatives or outside sources not listed above: a. Amount: Person Giving: i. Person Receiving: 14) Additional Information. Please provide any additional information that has not been represented above. If you have not indicated any amounts above, please provide a brief explanation of the resources that support the family in 2024:

FAQs

Who should complete the parental information section on this worksheet?

If the student was required to provide parental information on the FAFSA, answer for the parent(s) whose information is on the FAFSA. If not required (independent student), answer for the student (and spouse if married).

How should annual amounts be calculated for items listed in 2024?

If the same amount was paid or received each month in 2024, multiply that amount by the number of months. If amounts varied, add the monthly amounts. Do not leave blanks; enter N/A when an item does not apply.

What types of federal benefits are requested in Section 1?

Section 1 requests checkboxes for specific federal benefits received in 2024 or 2025, including Medicaid or SSI, SNAP/Food Stamps, free or reduced school lunch benefits (if eligible), TANF, WIC, EIC, federal housing assistance, and refundable credits under a qualified health plan.

Oct 22, 2026

Uploaded by Putri