Verification of Income Information for Parent Nontax Filers

Student Name

Student SMC ID

Info

The instructions and certifications below apply to each parent included in the household. Complete this section if the parents did not file and are not required to file an income tax return with the Internal Revenue Service (IRS). Please note that an IRS Verification of Nonfiling Letter is required -- see instructions below.

Check the box that applies

Neither parent was employed, and neither had income earned from work.

One or both parents were employed and have listed below the names of all employers, the amount earned from each employer, and whether an IRS W-2 form is provided. List every employer even if they did not issue an IRS W-2 form.

Info 2

Attach copies of all IRS W-2 forms issued to the parents by their employers. List every employer even if they did not issue an IRS W-2 form.

An IRS Verification of Nonfiling Letter or other confirmation of nonfiling from the IRS is required and can be requested by completing, and mailing IRS Form 4506-T and checking Box 7. Form 4506-T is available at https://www.irs.gov/form4506t.

Employer 1

Employer’s Name

Amount Earned

IRS W-2

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Employer 2

Employer’s Name

Amount Earned

IRS W-2

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Employer 3

Employer’s Name

Amount Earned

IRS W-2

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Employer 4

Employer’s Name

Amount Earned

IRS W-2

One file only.
2 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Total Amount of Income Earned From Work

Certification

I certify that all of the information reported on this worksheet is complete and correct.