DRAFT DATE: 11/12/14 

SAMPLE DATA

STUDENT AID REPORT

ACKNOWLEDGEMENT

Dear

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2015-2016 

Free Application for Federal Student Aid (FAFSA).

Application Status (review the checked boxes)

Federal Student Aid Eligibility (review the checked boxes)

You should keep this SAR Acknowledgement for your records!

PAGE 1 OF 3

WWW.FAFSA.GOV OMB No. 1845-0001

DATA RELEASE NUMBER (DRN):

2015-2016

The EFC is not the amount of money that your family must provide. Rather, you should think of the EFC as an index that 

colleges use to determine how much financial aid you would receive if you were to attend their school. Financial aid may 

include grants (free funds that do not have to be repaid), work-study (paid part-time employment), and/or low-interest 

loans (borrowed funds that must be repaid). This award information will vary from college to college because the cost of 

attending each is different. Please note that your EFC is subject to change if you update or correct your FAFSA. For more 

information about the EFC and other sources of aid, go to StudentAid.gov.

You should keep this SAR Acknowledgement for your records!

AUGUST 21, 2015

000117C041

JOHN SMITH

742 EVERGREEN TERRACE

SPRINGFIELD OH 55555

2245

EXPECTED FAMILY CONTRIBUTION (EFC): 000000 C

Your FAFSA appears to be complete. Review the data on pages 2 and 3. We may have assumed certain information to 

calculate your eligibility for federal student aid. We printed any assumptions we made and the word "assumed" for the 

items on the back of this page. If you need to make corrections, you can go to www.fafsa.gov to access your information 

or you can contact the financial aid office at one of the schools you listed on your application for assistance. The school(s) 

listed on your FAFSA will receive your information.

999999C999 01234567891SM01

JOHN SMITH,

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 000000.

)

F 211 1516

) We sent your information to other federal agencies through computer matching programs to verify your eligibility for 

federal student aid and there appears to be an issue with the information provided on your application. You can 

review information about these issues by going to www.fafsa.gov and selecting View your Student Aid Report (SAR), 

and more. You must work with your financial aid office to resolve any data matching issues before we can 

determine if you are eligible to receive federal student aid.

) Unless you are completing the verification process, it may be too late for you to make corrections or give us any more 

information this year. If you are completing verification and you need to correct your information, contact the FAA at 

your school for assistance. We must have your corrections no later than September 17, 2016.

) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $5730, provided you have not 

met or exceeded the lifetime limit established for the Federal Pell Grant program. You may also be eligible for other 

grants, work-study opportunities, and low-interest student loans. Your Financial Aid Administrator (FAA) will determine 

what types of aid and how much you are eligible to receive.
DRAFT DATE: 11/12/14 

SAMPLE DATA

20. DATE YOU BECAME A LEGAL RESIDENT

This section contains information from your student aid application (shaded items display parents' information, if provided). If you need to make 

corrections, visit www.fafsa.gov or contact the financial aid office at your college.

1. LAST NAME

2. FIRST NAME

3. MIDDLE INITIAL

4. ADDRESS

5. CITY

6. STATE ABBREVIATION

7. ZIP CODE

8. SOCIAL SECURITY NUMBER

9. DATE OF BIRTH

10. YOUR TELEPHONE NUMBER

11. DRIVER'S LICENSE NUMBER

12. DRIVER'S LICENSE STATE ABBREVIATION

13. ST E-MAIL

14. CITIZENSHIP STATUS

15. ALIEN REGISTRATION NUMBER

16. MARITAL STATUS

17. DATE OF MARITAL STATUS

18. STATE OF LEGAL RESIDENCE ABBREVIATION

19. LEGAL RESIDENT BEFORE JANUARY 1, 2010?

21. ARE YOU MALE OR FEMALE?

22. REGISTER YOU FOR SELECTIVE SERVICE?

23. DRUG CONVICTION AFFECTING ELIGIBILITY?

30. TYPE OF DEGREE/CERTIFICATE

29. GRADE LEVEL IN COLLEGE IN 2015-2016

31. INTERESTED IN WORK-STUDY?

32. FILED 2014 INCOME TAX RETURN

33. TYPE OF 2014 TAX FORM USED

35. ELIGIBLE TO FILE 1040A OR 1040EZ?

36. ADJUSTED GROSS INCOME FROM IRS FORM

37. U.S. INCOME TAX PAID

38. EXEMPTIONS CLAIMED

39. STUDENT'S INCOME EARNED FROM WORK

40. SPOUSE'S INCOME EARNED FROM WORK

41. CASH, SAVINGS, AND CHECKING

42. NET WORTH OF INVESTMENTS

43. NET WORTH OF BUSINESS/INVESTMENT FARMS

44. STUDENT'S ADDITIONAL FINANCIAL INFORMATION

a) EDUCATION CREDITS

b) CHILD SUPPORT PAID

c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT

d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED

e) COMBAT PAY/SPECIAL COMBAT PAY 

45. STUDENT'S UNTAXED INCOME

a) TAX-DEFERRED PENSION/SAVINGS

b) IRA DEDUCTIONS AND PAYMENTS

c) CHILD SUPPORT RECEIVED

d) TAX-EXEMPT INTEREST INCOME

e) UNTAXED IRA DISTRIBUTIONS

f) UNTAXED PORTIONS OF PENSIONS

g) MILITARY OR CLERGY ALLOWANCES

h) VETERANS NONEDUCATION BENEFITS

i) OTHER UNTAXED INCOME

j) MONEY RECEIVED OR PAID ON YOUR BEHALF

46. BORN BEFORE 1-1-1992?

48. WORKING ON MASTER'S OR DOCTORATE?

47. ARE YOU MARRIED?

51. HAVE CHILDREN YOU SUPPORT?

52. DEPENDENTS OTHER THAN CHILDREN/SPOUSE?

53. PARENTS DECEASED, FOSTER CARE, WARD OF COURT?

49. ON ACTIVE DUTY IN U.S. ARMED FORCES?

50. VETERAN OF U.S. ARMED FORCES?

54. ARE/WERE AN EMANCIPATED MINOR?

55. ARE/WERE IN LEGAL GUARDIANSHIP?

56. VERIFIED AS A HOMELESS YOUTH?

58. VERIFIED AS UNACCOMPANIED YOUTH AT RISK FOR 

HOMELESS?

PAGE 2 OF 3

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

57. DETERMINED BY DEPARTMENT OF HOUSING AND 

URBAN DEVELOPMENT THAT YOU WERE HOMELESS?

24. PARENT 1 EDUCATIONAL LEVEL

25. PARENT 2 EDUCATIONAL LEVEL

26. HIGH SCHOOL COMPLETION STATUS?

28. FIRST BACHELOR'S DEGREE BY 7-1-2015?

60. PARENTS' MARITAL STATUS DATE

61. PARENT 1 SOCIAL SECURITY NUMBER

62. PARENT 1 LAST NAME

63. PARENT 1 FIRST INITIAL

64. PARENT 1 DATE OF BIRTH

65. PARENT 2 SOCIAL SECURITY NUMBER

66. PARENT 2 LAST NAME

f) COOPERATIVE EDUCATION PROGRAM EARNINGS $

27.a HS NAME

27.b HS CITY

27.c HS STATE

SMITH

JOHN

12344 ABCDEFGHIJKLMNOPQRSTUVWXYZABC

ABCDEFGHIJKLMNOP

AB

12345

XXX-XX-1234

JANUARY 30, 1992

(999)999-9999

A-1234-446-789-012-3

AB

(ELIG NONCIT ASSUMED)

A123446789

(MARRIED ASSUMED)

JANUARY 2005

AB

JANUARY 2012

MALE

REGISTER ME

ELIGIBLE FOR AID

COLLEGE

COLLEGE

GED/STATE EQUIVALENT TEST

1ST BA

1ST PREV ATTENDED

YES

WILL FILE

U.S. TRUST TERRITORY

YES

(-1,123,446 ASSUMED)

(0 ASSUMED)

(1,123,446 ASSUMED)

(1,123,446 ASSUMED)

1,123,446

1,123,446

00

YES

PRINCE GEORGE'S COUNTY HIGH SCHOOL

BELTSVILLE

MD

1,123,446

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

DECEMBER 1990

XXX-XX-1234

ABCDEFGHIJKLMNOP

X

JANUARY 23, 1973

XXX-XX-1234

ABCDEFGHIJKLMNOP

999999C999 01234567891SM01

67. PARENT 2 FIRST INITIAL

68. PARENT 2 DATE OF BIRTH

69. PAR EMAIL CHRISTOPHER.E.STUDENTS.MOTHER@HOME.COMCAST.COM

70. PARENTS' STATE OF LEGAL RESIDENCE

JANUARY 24, 1972

D

AB

34. TAX RETURN FILING STATUS 2014 MARRIED-FILED SEPARATE 

RETURN

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

1,123,446

71. LEGAL RESIDENT BEFORE JANUARY 1, 2010?

72. DATE PARENT BECAME LEGAL RESIDENT DECEMBER 2012

UNMARRIED AND BOTH PARENTS LIVING 

TOGETHER

59. PARENTS' MARITAL STATUS

NO

NO
DRAFT DATE: 11/12/14 

SAMPLE DATA

100. RECEIVED TANF?

101. RECEIVED WIC?

102. STUDENT OR SPOUSE A DISLOCATED WORKER?

104. DATE COMPLETED

105. SIGNED BY

106. PREPARER'S SOCIAL SECURITY NUMBER

107. PREPARER'S EIN

108. PREPARER'S SIGNATURE

PAGE 3 OF 3

$

103.a FIRST COLLEGE NAME

103.b FIRST HOUSING PLAN

103.c SECOND COLLEGE NAME

103.d SECOND HOUSING PLAN

103.e THIRD COLLEGE NAME

103.f THIRD HOUSING PLAN

103.g FOURTH COLLEGE NAME

103.h FOURTH HOUSING PLAN

$

79. RECEIVED WIC?

80. PARENT(S) FILED 2014 TAX RETURN

81. TYPE OF 2014 TAX FORM USED

83. ELIGIBLE TO FILE A 1040A OR 1040EZ?

84. EITHER OF PARENTS A DISLOCATED WORKER?

85. ADJUSTED GROSS INCOME FROM IRS FORM

86. U.S. INCOME TAX PAID

87. EXEMPTIONS CLAIMED

88. PARENT 1 INCOME EARNED FROM WORK

89. PARENT 2 INCOME EARNED FROM WORK

90. CASH, SAVINGS, AND CHECKING

91. NET WORTH OF INVESTMENTS

92. NET WORTH OF BUSINESS/INVESTMENT FARMS

93. PARENTS' ADDITIONAL FINANCIAL INFORMATION 

a) EDUCATION CREDITS

b) CHILD SUPPORT PAID

c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT

d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED

e) COMBAT PAY/SPECIAL COMBAT PAY 

$

$

$

$

$

$

$

$

$

$

$

$

73. NUMBER OF FAMILY MEMBERS IN 2015-2016

74. NUMBER IN COLLEGE IN 2015-2016

75. PARENT RECEIVED SSI?

76. RECEIVED SNAP?

77. RECEIVED FREE/REDUCED PRICE LUNCH?

78. RECEIVED TANF?

f) COOPERATIVE EDUCATION PROGRAM EARNINGS $

b) IRA DEDUCTIONS AND PAYMENTS

c) CHILD SUPPORT RECEIVED

d) TAX-EXEMPT INTEREST INCOME

e) UNTAXED IRA DISTRIBUTIONS

f) UNTAXED PORTIONS OF PENSIONS

g) MILITARY OR CLERGY ALLOWANCES

h) VETERANS NONEDUCATION BENEFITS

i) OTHER UNTAXED INCOME

95. NUMBER OF FAMILY MEMBERS IN 2015-2016

96. NUMBER IN COLLEGE IN 2015-2016

97. STUDENT RECEIVED SSI?

98. RECEIVED SNAP?

99. RECEIVED FREE/REDUCED PRICE LUNCH?

$

$

$

$

$

$

$

$

94. PARENTS' UNTAXED INCOME

a) TAX-DEFERRED PENSION/SAVINGS $

For Financial Aid Office Use Only

Transaction Source:

Verification Flag:

SAR C Flag:

Application Receipt Date:

Transaction Process Date:

Transaction Receipt Date:

SSN Match Flag:

Expected Family Contribution: Primary

Secondary

Automatic Zero EFC Flag:

Dependency Status:

Formula Type:

Simplified Needs Test Flag:

Professional Judgment:

Dependency Override:

Hold Code:

Pell Eligible Flag:

Duplicate SSN Flag:

DHS Match Flag:

DHS Sec. Conf. Flag:

NSLDS Match Flag:

Selective Service Registration Flag:

DHS Verification #:

VA Match Flag:

NSLDS Results Flag:

NSLDS Transaction Number:

Selective Service Match:

SSA Citizenship Code:

P1SSN Match Flag:

P2SSN Match Flag:

Special Circumstances:

IRS Request Flag: Student: Parent: High School Flag:

THE PENNSYLVANIA STATE UNIVERSITY NEW KENSINGTON CAMPUS COMMON

VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY

UNIVERSITY OF MARYLAND COLLEGE PARK

UNIVERSITY OF MASSACHUSETTS AMHERST

Your FAFSA information was sent to all the colleges you listed although they are not all shown here. To see all of the colleges you listed, go to 

www.fafsa.gov and select "View your Student Aid Report (SAR), and more".

YES

YES

WILL FILE

U.S. TRUST TERRITORY

YES

(-1,123,456 ASSUMED)

(0 ASSUMED)

03

(1,123,456 ASSUMED)

(1,123,456 ASSUMED)

1,123,456

1,123,456

1,123,456

03

2

YES

YES

YES

YES

1,112,345

NOVEMBER 23, 2015

STUDENT

REPORTED

REPORTED

SIGNED

NO

NO

NO

NO

NO

ON CAMPUS

OFF CAMPUS

ON CAMPUS

OFF CAMPUS

999999C999 01234567891SM01

4A

Y

Y

04/21/2015

04/21/2015

04/21/2015

4

4

8

2

000000

000000

Y

2

Y

N

N

1

1

999999999999999

Y

X

Y

N

A

4

8

1

Y

Reject Code(s): 01 02 03 04 05 06 07

Comment Codes: 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

1,112,345

NSLDS Unusual Enrollment History Flag: 1

82. TAX RETURN FILING STATUS 2014 MARRIED-FILED SEPARATE 

RETURN

01 01 IRS Display Flag: Student: Parent: A C