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Outline

The Illinois Income Verification form is a crucial document used primarily for determining eligibility for various assistance programs, including those offered by Illinois Action for Children. This form requires input from both the employee and the employer, ensuring that accurate income information is provided. Clients must fill out their personal details, including their name and case number, and authorize their employer to release income information. The employer, in turn, must confirm employment details such as the type of business, hours worked, and payment frequency. Additionally, the employer is responsible for providing the employee's gross pay and any tips or commissions received. The form emphasizes the importance of accuracy, as it may be subject to verification by the agency. Notably, this document is not a one-time submission; clients will need to provide further income proof during their next redetermination process. Understanding the nuances of this form can help ensure a smoother application experience for those seeking assistance.

Sample - Illinois Income Verification Form

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.

 

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

 

a.m.

 

 

 

 

p.m.

 

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

 

p.m.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To:

 

a.m.

 

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

 

a.m.

 

 

 

 

p.m.

 

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

p.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-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Information

Fact Name Detail
Purpose The Illinois Income Verification form is designed to verify an employee's income for initial eligibility in programs administered by Illinois Action for Children.
Signature Requirement This form must be signed by the employee's employer before submission to ensure authenticity and compliance.
Additional Documentation Clients are informed that additional proof of income will be required during their next redetermination, emphasizing the ongoing nature of income verification.
Employer's Role Employers are responsible for filling out specific sections of the form, including employment details and payment information, to provide a complete picture of the employee's earnings.
Governing Law This form operates under the guidelines set forth by the Illinois Department of Human Services, which regulates eligibility for state assistance programs.
Confidentiality By signing the form, the employee authorizes their employer to release income information, ensuring that confidentiality is maintained while allowing for necessary verification.

Detailed Guide for Filling Out Illinois Income Verification

Once you have the Illinois Income Verification form ready, it’s important to fill it out accurately to ensure that your information is processed correctly. Follow the steps below to complete the form properly.

  1. Begin by entering your Client’s Name at the top of the form.
  2. Next, fill in your Case Number.
  3. Provide the Employee’s Name in the designated space.
  4. Sign the authorization statement, allowing your employer to release information to Illinois Action for Children.
  5. Write the date next to your signature.
  6. Now, hand the form over to your employer for them to complete their section.
  7. Your employer should fill in the Name of Business if applicable.
  8. They need to specify the Type of Business or Work Performed.
  9. Next, they should enter their name as the Business Owner or Employer.
  10. Provide the Business Address and Business Phone number.
  11. Your employer must indicate the Start Date of Current Employment.
  12. They should also note the Average Number of Hours Worked per Week.
  13. In the payment section, your employer will check how you are paid: Cash, Personal Check, Payroll Check, or Other.
  14. Then, they need to specify how often you are paid: Weekly, Biweekly, Semi-monthly, or Monthly.
  15. Your employer must provide your Gross Amount per Pay Period. If this varies, they should give an average amount.
  16. They should also fill in your Gross Hourly Wage.
  17. Next, they need to estimate your Weekly Tips or Commissions.
  18. Your employer should provide your typical work schedule by indicating the hours worked each day.
  19. Finally, your employer must sign the form, affirming the accuracy of the information provided.
  20. They should also include their SSN/FEIN and phone number.

After completing the form, ensure that both you and your employer have signed it. Once signed, submit the form to the designated office for processing.

Obtain Answers on Illinois Income Verification

  1. What is the Illinois Income Verification form?

    The Illinois Income Verification form is a document used to confirm an employee's income for eligibility purposes. It is typically required by Illinois Action for Children to assess whether individuals qualify for various assistance programs. This form must be completed and signed by both the employee and their employer.

  2. Who needs to fill out the form?

    Both the employee and the employer must complete the form. The employee provides their personal information and authorizes their employer to release income details. The employer, in turn, fills out specific information about the business and the employee's earnings.

  3. Why is my employer's signature required?

    The employer's signature is crucial as it verifies the accuracy of the information provided about the employee's income. This ensures that the details submitted to Illinois Action for Children are legitimate and can be relied upon during the eligibility assessment.

  4. What information does the employer need to provide?

    The employer must provide several key details, including:

    • Name and address of the business
    • Type of business
    • Employee's start date
    • Average number of hours worked per week
    • Payment method and frequency
    • Gross amount earned per pay period
    • Typical work schedule

  5. How is the information verified?

    Illinois Action for Children may contact the employer by phone to verify the information provided in the form. This step helps to ensure that the income details are accurate and up-to-date, which is essential for determining eligibility for assistance programs.

  6. What happens after submitting the form?

    Once the form is submitted, it will be reviewed by Illinois Action for Children. If additional proof of income is required, the employee will be asked to provide further documentation during their next redetermination process. It is important to keep records of income and any changes in employment status.

  7. What if my income changes after submitting the form?

    If there are changes in your income after you have submitted the Illinois Income Verification form, it is essential to report these changes as soon as possible. Keeping your information current helps ensure that you remain eligible for any assistance programs you are enrolled in.

Common mistakes

Filling out the Illinois Income Verification form can seem straightforward, but many people make common mistakes that can delay the process or lead to complications. Here are nine frequent errors to avoid.

First, one of the most common mistakes is failing to obtain the necessary employer signature. This form must be signed by the employer before submission. Without this signature, the form is incomplete and cannot be processed. Always double-check that the employer has signed the document.

Another mistake is neglecting to provide accurate information about the employee's hours worked. The form asks for the actual or average number of hours worked per week. If this information is incorrect, it can lead to misunderstandings about income and eligibility. Ensure that the hours reported reflect the employee's typical work schedule.

People often forget to specify the method of payment. The form includes options such as cash, personal check, and payroll check. Marking the correct payment method is essential for clarity. Incorrect or missing information can lead to confusion and delays.

Additionally, individuals sometimes overlook the section that asks for the gross amount earned per pay period. If the employee's pay varies, the average amount should be provided. This is crucial for determining eligibility, so be sure to include this information accurately.

Another frequent oversight is failing to indicate the frequency of payment. The form requires you to check whether the employee is paid weekly, biweekly, semi-monthly, or monthly. Missing this detail can result in complications when verifying income.

Many people also forget to include the employee's gross hourly wage. This detail is important for assessing the employee's overall income. If this information is missing, it may raise questions during the review process.

Moreover, when reporting tips or commissions, individuals sometimes provide inaccurate estimates or leave this section blank. Even if tips vary, providing an estimate is essential. This helps create a clearer picture of the employee's total income.

Another common error is not providing a complete work schedule. The form asks for a typical work schedule, including start and end times. Incomplete or vague information can hinder the verification process.

Lastly, individuals may forget to sign and date the form themselves. This step is just as important as the employer's signature. A missing signature can lead to the form being rejected, causing unnecessary delays.

By being mindful of these common mistakes, you can ensure that your Illinois Income Verification form is filled out correctly and completely. This will help streamline the process and avoid any potential issues down the line.

Documents used along the form

The Illinois Income Verification form is a crucial document for individuals seeking assistance from Illinois Action for Children. Along with this form, several other documents may be required to support the income verification process. Each of these documents plays a significant role in establishing eligibility and ensuring that all information is accurate and complete.

  • Pay Stubs: Recent pay stubs provide proof of income by detailing the employee's earnings over a specific period. They typically show gross pay, deductions, and net pay, offering a clear picture of an individual's financial situation.
  • Tax Returns: Previous years' tax returns are often requested to verify income consistency over time. They include comprehensive information about total income, deductions, and tax obligations, which can help assess overall financial health.
  • W-2 Forms: Employers issue W-2 forms at the end of each tax year, summarizing an employee's earnings and taxes withheld. These forms are essential for verifying annual income and ensuring that reported earnings align with tax records.
  • Employment Verification Letter: This letter, provided by an employer, confirms the employee's job title, salary, and duration of employment. It serves as an official statement of employment status and income, which can support the claims made in the Income Verification form.

In summary, the Illinois Income Verification form works in conjunction with these other documents to create a comprehensive picture of an individual's income. Together, they facilitate the eligibility determination process and ensure that assistance is provided to those who truly qualify.

Similar forms

The Illinois Income Verification form serves a specific purpose in confirming an individual's income for eligibility assessments. Several other documents share similar functions in different contexts. Below are six documents that are comparable to the Illinois Income Verification form, each serving to verify income or employment status in various situations.

  • W-2 Form: This form reports an employee's annual wages and the taxes withheld from their paycheck. Like the Illinois Income Verification form, it provides essential information about an individual's earnings, often required for tax purposes or loan applications.
  • Pay Stub: A pay stub details the earnings of an employee for a specific pay period, including deductions. Similar to the Illinois form, it serves as proof of income and is often requested by landlords or financial institutions.
  • 1099 Form: Used primarily by independent contractors, the 1099 form reports income received outside of traditional employment. It parallels the Illinois Income Verification form in that it verifies income but is tailored for non-employees.
  • Employment Verification Letter: This letter, typically provided by an employer, confirms an individual's employment status and salary. It serves a similar role to the Illinois form by providing third-party verification of income and employment.
  • Tax Return (Form 1040): A personal tax return outlines an individual's income, deductions, and tax liabilities for the year. It is a comprehensive document that can be used to verify income, much like the Illinois Income Verification form during eligibility checks.
  • Social Security Administration Income Verification: This document provides proof of income for individuals receiving Social Security benefits. It is similar to the Illinois form in that it confirms income levels for eligibility assessments in various programs.

Dos and Don'ts

When filling out the Illinois Income Verification form, it’s important to follow certain guidelines to ensure the process goes smoothly. Here are some dos and don’ts to keep in mind:

  • Do make sure to provide accurate information about your employment.
  • Do have your employer sign the form before submission.
  • Do indicate your typical work schedule clearly.
  • Do specify how you are paid, whether by cash, check, or payroll.
  • Don’t leave any sections blank; fill out all required fields.
  • Don’t provide false information, as this can lead to penalties.
  • Don’t forget to keep a copy of the completed form for your records.
  • Don’t submit the form without your signature and your employer’s signature.

Misconceptions

Understanding the Illinois Income Verification form can be challenging, especially with the various misconceptions that can arise. Here are some common myths and the truths behind them:

  • Only low-income individuals need to fill it out. Many people believe this form is exclusive to low-income earners. In reality, it is required for anyone seeking assistance, regardless of their income level.
  • It only needs to be filled out once. Some think that submitting the form once is sufficient. However, you will need to provide updates and additional proof of income during the Redetermination process.
  • Employers can refuse to complete the form. It’s a common misconception that employers can simply decline to fill out the form. If an employee requests it, employers are generally obligated to provide the necessary information.
  • The form is only for full-time employees. Many assume that only full-time workers need to complete the form. Part-time employees also need to provide their income verification, as it is essential for eligibility.
  • Submitting the form guarantees assistance. Some believe that just because they submit the form, they will automatically receive aid. In truth, the form is just one step in a larger eligibility process.
  • It’s a simple form, so it doesn’t need to be accurate. While the form may appear straightforward, accuracy is crucial. Any discrepancies can lead to delays or denial of assistance.
  • Only the employee’s signature is needed. There’s a misconception that only the employee's signature is necessary. However, the employer must also sign to verify the information provided.
  • The form can be submitted without employer verification. Some think they can submit the form without it being signed by their employer. This is incorrect, as the employer's signature is essential for the form to be valid.

By clearing up these misconceptions, you can navigate the Illinois Income Verification form more effectively. Understanding the requirements and processes can help ensure that you receive the assistance you need.

Key takeaways

When filling out and utilizing the Illinois Income Verification form, it is essential to keep several key points in mind to ensure a smooth process.

  • Employer Signature Required: The form must be signed by your employer before it can be submitted. This signature confirms the accuracy of the information provided.
  • Initial Eligibility: This form is primarily for determining initial eligibility. Be prepared to provide additional income proof 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. This is a crucial step in the verification process.
  • Verification Process: Illinois Action for Children may contact your employer directly to verify the information submitted on the form. This can include a phone call for clarification.
  • Detailing Income: Make sure to provide accurate figures regarding your gross income, including any tips or commissions. If your pay varies, an average amount should be noted.
  • Typical Work Schedule: You will need to indicate your typical work hours. This includes specifying whether hours worked are during the a.m. or p.m., which helps in understanding your employment pattern.

By paying attention to these details, you can ensure that your Illinois Income Verification form is completed correctly and efficiently, facilitating your eligibility review process.