STEP 5: FOOD STAMP BENEFITS CALENDAR YEAR 2014 and/or 2015 – Did someone in the student’s household (listed in STEP 2) received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2014 and/or 2015 calendar years? No Continue to Step 6 – Yes of the persons listed in STEP 2 of this worksheet received SNAP benefits during the 2014 and/or 2015 –One calendar years. STEP 6: CHILD SUPPORT PAID CALENDAR YEAR 2015 – Did you or your spouse pay child support in 2015? No Continue to Step 7. – Yes, Please certify the following: Name of Person Who Paid Child Name of Person to Whom Name of Child for Whom Amount of Child Support Paid Support Child Support was Paid Support Was paid in 2015 STEP 7: OTHER UNTAXED INCOME CALENDAR YEAR 2015 – Please indicate in the boxes below any untaxed income you or your spouse received for calendar year 2015. If you or your spouse did not receive any of the following, please mark the spaces below with a ‘0’. Payments to tax-deferred pension and retirement savings List any payments (direct or withheld from earnings) to tax-deferred pension 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 12 d with codes D, E, F, G, H, and S. Name of Person Who Made the Payment Amount Paid in 2015 Child Support Received List the actual amount of any child support received in 2015 for the children in your household. Do not include foster care payments, adoption payments, or any amount that was but not actually paid. Name of Adult Who Received the Support Name of Child For Whom Support Was Received Amount of Child Support Received in 2015 Housing, food, and other living allowance paid to members of the military, clergy, and others
STEP 5: FOOD STAMP BENEFITS – CALENDAR YEAR 2014 and/or 2015 Did someone in the student’s household (listed in STEP 2) received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2014 and/or 2015 calendar years? No – Continue to Step 6 Yes –One of the persons listed in STEP 2 of this worksheet received SNAP benefits during the 2014 and/or 2015 calendar years. STEP 6: CHILD SUPPORT PAID – CALENDAR YEAR 2015 Did you or your spouse pay child support in 2015? No – Continue to Step 7. Yes, Please certify the following: Name of Person Who Paid Child Support Name of Person to Whom Child Support was Paid Name of Child for Whom Support Was paid Amount of Child Support Paid in 2015 STEP 7: OTHER UNTAXED INCOME – CALENDAR YEAR 2015 Please indicate in the boxes below any untaxed income you or your spouse received for calendar year 2015. If you or your spouse did not receive any of the following, please mark the spaces below with a ‘0’. Payments to tax-deferred pension and retirement savings List any payments (direct or withheld from earnings) to tax-deferred pension 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 12 d with codes D, E, F, G, H, and S. Name of Person Who Made the Payment Amount Paid in 2015 Child Support Received List the actual amount of any child support received in 2015 for the children in your household. Do not include foster care payments, adoption payments, or any amount that was but not actually paid. Name of Adult Who Received the Support Name of Child For Whom Support Was Received Amount of Child Support Received in 2015 Housing, food, and other living allowance paid to members of the military, clergy, and others
V6-2016-17%20PIT%20Independent%20VWS.docx