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Blank Illinois Income Verification PDF Form

The Illinois Income Verification form is a document required for individuals seeking to verify their income for eligibility purposes. This form must be completed and signed by the employer before submission to the appropriate office. To ensure a smooth process, clients are encouraged to fill out the form accurately and submit it promptly.

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Blank Illinois Income Verification PDF Form

Article Guide

The Illinois Income Verification form plays a crucial role in the process of determining eligibility for various assistance programs. This form is designed to collect essential information about an employee's income and employment status, which is necessary for organizations such as Illinois Action for Children to assess eligibility for services. Clients must complete the first section, providing their name, case number, and the name of their employer, and they must authorize their employer to disclose specific income information. The employer then fills out the second section, detailing the business name, type of work performed, and the employee's employment specifics, including hours worked, pay frequency, and gross income. Additionally, employers must confirm the accuracy of the information provided by signing the form. It is important to note that this form is used for initial eligibility determination, and clients will be required to submit further proof of income during their next redetermination. Understanding the structure and requirements of the Illinois Income Verification form is essential for both employees seeking assistance and employers providing necessary documentation.

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CCAP_IV.doc rev. 8/10/2006

INCOME VERIFICATION

1340 S Damen Avenue 3rd Floor CHICAGO, IL 60608 phone: (312) 823-1100 fax: (312) 823-1200

Attention Client: This form must be signed by your

employer before submitting to our office.

TO BE FILLED OUT BY CLIENT:

Client’s Name:

Case Number:

Employee’s Name:

I authorize my employer to release the following information to Illinois Action for Children. I understand this form is for initial eligibility purposes and that I will be asked to submit additional proof of my income with my next Redetermination. I understand that Action for Children may need to verify this information or contact the employer by phone.

Employee’s Signature:

Date:

TO BE FILLED OUT BY EMPLOYER:

Name of business (if applicable):

Type of business or work performed:

Name of business owner or employer:

Business address:

Business phone: (

)

Start date of current employment:

Actual—or average—number of hours worked by the employee per week:

The employee is paid by (check one): Cash Personal check Payroll check Other (please specify):

The employee is paid (check one):

Weekly Biweekly Semi-monthly

Monthly

The employee receives a gross amount of $

per pay period. (If amount varies, please give average amount.)

The employee’s gross hourly wage: $

per hour

The employee receives weekly tips or commissions in this estimated amount: $

per week

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

From:

a.m.

p.m.

To:

a.m.

p.m.

Please give the employee’s typical work schedule. (Circle either “a.m.” or “p.m.” in each applicable box.)

I verify that the above information is true and correct to the best of my knowledge.

Business Owner or Employer’s Signature:

Date:

Business Owner or Employer’s SSN/FEIN:

Phone:

FOR INTERNAL USE ONLY

T-

➤ PDF File

Form Specifications

Fact Name	Description
Purpose	The Illinois Income Verification form is used to verify an employee's income for eligibility in programs administered by Illinois Action for Children.
Client Responsibility	Clients must ensure that their employer signs the form before submission to ensure its validity.
Employer's Role	Employers must fill out specific sections of the form, including details about the business and the employee's earnings.
Frequency of Payment	The form allows employers to indicate how often the employee is paid, such as weekly, biweekly, semi-monthly, or monthly.
Gross Income Reporting	Employers are required to report the employee's gross income per pay period, or an average if the amount varies.
Work Hours	The form asks for the average number of hours the employee works each week, which is crucial for income assessment.
Verification Process	Illinois Action for Children may contact the employer to verify the information provided on the form.
Legal Requirement	This form is governed by state laws related to income verification for public assistance programs in Illinois.
Submission Timeline	Clients will need to submit this form as part of their initial eligibility process and may be required to provide additional documentation during redetermination.

Illinois Income Verification: Usage Guidelines

Once you have the Illinois Income Verification form in hand, it’s time to start filling it out. Ensure that you have all the necessary information ready, including your personal details and your employer’s information. After completing the form, it must be signed by your employer before submission. Follow the steps below to accurately fill out the form.

Write your name in the space provided for the Client’s Name.
Enter your Case Number in the designated area.
Fill in your Employee’s Name.
Sign the authorization statement, allowing your employer to release information to Illinois Action for Children.
Include the date of your signature.
For your employer’s section, have your employer fill in the Name of business if applicable.
Specify the Type of business or work performed.
Provide the Name of business owner or employer.
Complete the Business address and Business phone fields.
Indicate the Start date of current employment.
State the Actual—or average—number of hours worked per week.
Check the box that corresponds to how the employee is paid: Cash, Personal check, Payroll check, or Other.
Indicate the payment frequency by checking one of the options: Weekly, Biweekly, Semi-monthly, or Monthly.
Fill in the gross amount the employee receives per pay period, or provide an average if it varies.
Complete the gross hourly wage section.
Estimate the amount of weekly tips or commissions the employee receives.
Provide the employee’s typical work schedule by filling in the days and corresponding hours.
Finally, the employer must sign the verification statement, confirming that the provided information is true and correct.
Include the date of the employer’s signature and the Business Owner or Employer’s SSN/FEIN and phone number.

Your Questions, Answered

What is the purpose of the Illinois Income Verification form?

The Illinois Income Verification form is designed to collect information about an employee's income for eligibility assessment. This form is crucial for individuals applying for assistance through programs such as the Child Care Assistance Program (CCAP). It helps verify income levels to determine eligibility and ensures that applicants receive the appropriate support.

Who needs to fill out this form?

Both the employee and the employer must complete the form. The employee provides personal information and authorizes the employer to release their income details. The employer then fills out the section regarding the employee’s job details, pay structure, and hours worked. This collaborative effort is essential for accurate income verification.

What information does the employer need to provide?

The employer is required to supply several key details, including the business name, type of work performed, and the employee’s start date. Additionally, the employer must indicate the average number of hours the employee works each week, their pay frequency (e.g., weekly, biweekly), and the gross amount earned per pay period. If applicable, the employer should also provide information about any tips or commissions the employee may receive.

How is the information verified?

Once the form is submitted, Illinois Action for Children may contact the employer directly to verify the information provided. This step is critical to ensure the accuracy of the data and to uphold the integrity of the assistance programs. Employees should be aware that further proof of income may be requested during the next redetermination process.

What happens if the employer refuses to sign the form?

If an employer refuses to sign the Illinois Income Verification form, the employee may face challenges in proving their income. It is important for employees to communicate with their employers about the necessity of this form. If necessary, employees can seek alternative documentation of income, such as pay stubs or bank statements, to support their application.

Where should the completed form be submitted?

The completed Illinois Income Verification form should be submitted to the appropriate office, specifically Illinois Action for Children. The contact information for submission is provided on the form itself. This includes a mailing address, phone number, and fax number, ensuring that employees can easily reach out for assistance if needed.

Common mistakes

Filling out the Illinois Income Verification form can seem straightforward, but many people make common mistakes that can delay the process. Here’s a list of eight mistakes to watch out for:

Neglecting the Employer's Signature:
One of the most critical components of this form is the employer's signature. Without it, the form is incomplete and cannot be processed.
Missing Information:
Ensure all fields are filled out completely. Omitting details like the employee’s name or case number can lead to unnecessary delays.
Incorrect Income Reporting:
When reporting income, be precise. Providing an average amount when it varies is acceptable, but ensure that it reflects the employee's actual earnings.
Not Specifying Payment Method:
It’s important to check the appropriate box for how the employee is paid. Failing to do so can raise questions and complicate verification.
Inaccurate Work Schedule:
Double-check the work schedule provided. Incorrect times can lead to misunderstandings about the employee's availability and income.
Forgetting to Circle AM/PM:
When indicating the work schedule, don’t forget to circle either “a.m.” or “p.m.” in each applicable box. This detail is crucial for clarity.
Providing Outdated Information:
Always use the most current information available. If there have been recent changes in employment status or income, these should be reflected on the form.
Ignoring Follow-Up Requirements:
Remember that this form is just for initial eligibility. Additional proof of income will be required later, so keep records handy for future submissions.

By avoiding these common mistakes, you can help ensure that your Illinois Income Verification form is processed smoothly and efficiently. Taking the time to double-check your information can save you from future headaches.

Documents used along the form

The Illinois Income Verification form is an essential document for clients seeking assistance from Illinois Action for Children. Along with this form, several other documents are often required to provide a complete picture of an individual's financial situation. Below is a list of commonly used forms and documents that accompany the Income Verification form.

Pay Stubs: These are issued by employers and provide a record of an employee's earnings over a specific pay period. Pay stubs detail gross pay, deductions, and net pay, serving as proof of income.
W-2 Forms: Issued by employers at the end of the tax year, W-2 forms summarize an employee's total earnings and the taxes withheld. This document is crucial for verifying annual income.
Tax Returns: Clients may need to submit copies of their most recent tax returns, which provide a comprehensive overview of their financial situation, including income from various sources.
Bank Statements: These statements show the financial activity in a client's bank account over a specific period. They can help verify income and expenses, offering insight into the client's financial stability.
Employment Verification Letter: A letter from an employer confirming an employee's position, salary, and duration of employment. This document supports claims made in the Income Verification form.

Providing these additional documents along with the Illinois Income Verification form can streamline the eligibility process and ensure that clients receive the assistance they need in a timely manner.

Similar forms

The Illinois Income Verification form serves a specific purpose in verifying income for eligibility assessments. Several other documents share similar functions, often used in various contexts for income verification. Below is a list of six documents that are comparable to the Illinois Income Verification form:

W-2 Form: This document provides information about an employee's annual wages and the taxes withheld. Employers must issue it to employees, making it a key tool for verifying income.
Pay Stub: A pay stub details an employee's earnings for a specific pay period. It includes gross pay, deductions, and net pay, serving as proof of income for various applications.
1099 Form: Used for independent contractors, this form reports income received outside of traditional employment. It is essential for verifying income for self-employed individuals.
Bank Statements: These documents show deposits and withdrawals from an individual's bank account. They can provide insight into income sources and financial stability.
Income Tax Return: A tax return outlines an individual's earnings and tax obligations for the year. It serves as a comprehensive document for income verification during applications for loans or assistance programs.
Social Security Administration (SSA) Benefit Verification Letter: This letter confirms the amount of benefits an individual receives from Social Security. It is important for verifying income for those relying on government assistance.

Dos and Don'ts

When filling out the Illinois Income Verification form, it is essential to approach the task with care. Here are four important do's and don'ts to keep in mind:

Do ensure accuracy. Double-check all entries for spelling and numerical errors. Inaccurate information can lead to delays or complications.
Do have your employer sign the form. The employer's signature is crucial. Without it, the form may not be accepted.
Don't leave any sections blank. Fill out every required field. Missing information can result in the form being returned for corrections.
Don't forget to keep a copy. Retain a copy of the completed form for your records. This can be helpful for future reference or follow-up.

Misconceptions

Understanding the Illinois Income Verification form is crucial for both employees and employers. However, several misconceptions can lead to confusion. Here are nine common misunderstandings:

Only employees need to fill out the form. Many believe that only the employee's information is necessary. In reality, both the employee and employer must complete their respective sections for the form to be valid.
The form is only for new applicants. Some think this form is only required for initial eligibility. However, it is also needed during the redetermination process to verify ongoing income.
Employers can refuse to complete the form. Employers are required to provide accurate information about their employees. Refusal to complete the form can hinder the employee’s eligibility for benefits.
Any income verification is acceptable. Not all documents suffice. The specific Illinois Income Verification form must be used, as it is designed to meet particular state requirements.
It’s okay to leave sections blank. Omitting information can lead to delays or denials. Every section should be filled out completely to ensure the form's accuracy.
The form does not require a signature. A signature from both the employee and employer is essential. This confirms the information provided is truthful and accurate.
Submitting the form is the final step. After submission, additional documentation may be requested. It’s important to be prepared for follow-up requests for further proof of income.
Only hourly wages need to be reported. Employers must report all forms of compensation, including tips and commissions. This gives a complete picture of the employee’s income.
The form is only for full-time employees. Part-time employees also need to complete this form. Income verification applies to anyone receiving benefits, regardless of their work hours.

By clarifying these misconceptions, both employees and employers can navigate the income verification process more smoothly and ensure compliance with state requirements.

Key takeaways

When filling out and using the Illinois Income Verification form, keep these key takeaways in mind:

Employer Signature Required: Ensure that your employer signs the form before submitting it. This signature is essential for verification.
Initial Eligibility: Understand that this form is primarily for initial eligibility. Additional proof of income will be required during your next Redetermination.
Authorization to Release Information: By signing the form, you authorize your employer to share your income details with Illinois Action for Children.
Accurate Information: Both the employee and employer must provide accurate information regarding employment status, hours worked, and payment details.
Payment Method and Frequency: Clearly indicate how the employee is paid and the frequency of payments. This includes options like cash, checks, and payroll.
Typical Work Schedule: Employers should provide a typical work schedule. This helps in verifying the employee's hours and income consistency.