This form collects income that is untaxed by the IRS.
Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to ,amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H, and S
IRA deductions and payments to self-employed SEP, SIMPLE, and Keogh and other qualified plans from IRS Form 1040-line 28+ line 32 or 1040A-line 17
Child support received for all children. Don’t included foster care or adoption payments.
Tax exempt interest income from IRS Form 1040-line 8b or 1040A-line 8b.
Untaxed portions of IRA distributions from IRS Form 1040–lines (15a minus 15b) or 1040A-lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
Untaxed portions of pensions from IRS Form 1040-lines (16a minus 16b) or 1040A-lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). Don’t include the value of on-base military housing or the value of a basic military allowance for housing.
Veterans non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances.
Other untaxed income not reported, such as workers’ compensation, disability, etc. Also include the first-time homebuyer tax credit from IRS Form 1040-line 67. Don’t include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form.
Student's Signature: ________________________________________
Parent's Signature: ________________________________________
Office of Financial Aid
Box 93260 MSU
Lake Charles, LA 70609
Phone: (337) 475-5065
Fax: (337) 475-5068