Homepage Blank Illinois Wage Verification Form
Outline

The Illinois Wage Verification form serves as a crucial document in the state's childcare assistance program. Designed to facilitate the verification of an employee's income, this form requires the employer to provide specific details about the employee's job and compensation. Information such as the employee's name, start date, hourly pay rate, and any commissions or tips must be disclosed. The form also includes sections for the work schedule, allowing for flexibility in cases where hours may vary. Employers must complete this form accurately, as any fraudulent or misleading information could lead to significant consequences, including the potential loss of childcare payments. Additionally, the form must be signed by both the employee and the employer, ensuring that all provided information is verified and legitimate. It is essential for employers to return the completed form to Illinois Action for Children within ten business days to maintain compliance with the program's requirements.

Sample - Illinois Wage Verification Form

State of Illinois

Department of Human Services - Bureau of Child Care and Development

WAGE VERIFICATION

I hereby authorize my employer to release the following information to the Illinois Department of Human Services. I understand that this information may be verified by phone. Any fraudulent, false or misleading information given may result in loss of childcare payments and my child care case may be cancelled or denied.

Client Signature

Client Case NumberDate

JOB INFORMATION: TO BE COMPLETED BY YOUR EMPLOYER ONLY.

Employee Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Start Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rate of Hourly Pay:

 

 

 

 

 

Commission:

 

 

 

 

Tips:

 

 

(Monthly Average)

 

Pay Period:

Weekly:

 

 

Bi-Weekly:

 

 

 

Twice Per Month:

Monthly:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the employee paid cash?

 

Yes

 

No

Employee Job Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If on leave:

Return Date:

 

 

 

 

 

 

 

 

Type of Leave:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WORK SCHEDULE: If your schedule varies, provide an example of your schedule.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MON

 

TUES

 

 

 

 

WED

 

THURS

 

 

FRI

 

SAT

SUN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

AM

 

 

 

 

AM

 

AM

 

 

AM

 

 

 

AM

 

 

AM

AM

 

 

 

 

PM

 

 

 

 

PM

 

PM

 

 

PM

 

 

 

PM

 

 

PM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

AM

 

 

 

 

AM

 

AM

 

 

AM

 

 

 

AM

 

 

AM

AM

 

 

 

 

PM

 

 

 

 

PM

 

PM

 

 

PM

 

 

 

PM

 

 

PM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do these hours vary?

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer / Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address:

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name Printed

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

Employer Signature

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE RETURN FORM TO:

 

 

THIS FORM MUST BE COMPLETED BY YOUR

EMPLOYER AND RETURNED TO THE ADDRESS

AT THE RIGHT WITHIN 10 BUSINESS DAYS.

IL444-3514 (N-1-11)

Page 1 of 1

Form Information

Fact Name Description
Governing Law The Illinois Wage Verification form is governed by the Illinois Compiled Statutes, specifically under the Child Care Assistance Program.
Purpose This form is used to verify an employee's wages for the Illinois Department of Human Services, primarily for childcare assistance eligibility.
Employer Authorization Employees must authorize their employers to release wage information, ensuring that the Illinois Department of Human Services can verify the data.
Consequences of Fraud Providing false or misleading information may lead to the loss of childcare payments and possible cancellation or denial of the childcare case.
Completion Requirement The form must be completed by the employer, ensuring accurate and official wage information is provided.
Submission Timeline Employers are required to return the completed form to Illinois Action For Children within 10 business days.
Payment Details The form collects comprehensive payment details, including hourly pay, commissions, and tips, to assess the employee's financial situation.

Detailed Guide for Filling Out Illinois Wage Verification

Filling out the Illinois Wage Verification form is a straightforward process. This form must be completed by your employer to verify your employment details for the Illinois Department of Human Services. Once the form is filled out, it should be returned to the designated address within ten business days.

  1. Obtain the form: Make sure you have the Illinois Wage Verification form. You can get it from your employer or download it from the Illinois Department of Human Services website.
  2. Fill in your information: In the section labeled "Client Signature," provide your signature. Next, enter your Client Case Number and the Date you are filling out the form.
  3. Provide your employer's information: Your employer will need to complete the "JOB INFORMATION" section. They should fill in your Employee Name, Start Date, Rate of Hourly Pay, Commission, and Tips (monthly average).
  4. Indicate your pay period: Your employer must select the appropriate pay period: Weekly, Bi-Weekly, Twice Per Month, or Monthly.
  5. Cash payment: Your employer should indicate whether you are paid in cash by checking the corresponding box for Yes or No.
  6. Complete job title and leave information: Your employer needs to enter your Employee Job Title. If you are on leave, they should also provide the Return Date and the Type of Leave.
  7. Work schedule: If your schedule varies, your employer should provide an example of your hours worked for each day of the week in the "WORK SCHEDULE" section.
  8. Employer details: Your employer must fill in their Company Name, Employer Address, City, and Employer Phone Number.
  9. Employer signature: Finally, your employer should print their name, add their title, sign the form, and include the Date of signing.
  10. Return the form: Ensure that the completed form is returned to Illinois Action For Children at the address provided on the form within ten business days.

Obtain Answers on Illinois Wage Verification

  1. What is the Illinois Wage Verification form?

    The Illinois Wage Verification form is a document used to verify an employee's wages for the Illinois Department of Human Services. It is primarily utilized in the context of child care assistance programs, ensuring that accurate income information is available for determining eligibility for benefits.

  2. Who needs to fill out the form?

    This form must be completed by the employee's employer. It requires specific information about the employee's job, pay rate, work schedule, and any additional compensation such as commissions or tips. The employee also needs to authorize the release of this information.

  3. What information is required on the form?

    The form asks for various details, including:

    • Employee name
    • Start date of employment
    • Hourly pay rate
    • Commission and tips (monthly average)
    • Pay period frequency (weekly, bi-weekly, etc.)
    • Work schedule, including hours worked
    • Employer's contact information

  4. Why is this form important?

    This form plays a crucial role in determining eligibility for child care assistance. Accurate wage verification helps prevent fraud and ensures that benefits are allocated fairly. Providing false information can lead to significant consequences, including the loss of child care payments.

  5. How should the completed form be submitted?

    Once the employer completes the form, it must be returned to Illinois Action for Children at the specified address. It is important that this is done within 10 business days to avoid delays in processing child care assistance applications.

  6. What happens if the form is not submitted on time?

    If the form is not submitted within the required timeframe, it may result in delays or denials of child care assistance. It is essential to ensure that the employer is aware of the submission deadline to prevent any issues.

  7. Can the form be verified by phone?

    Yes, the information provided on the Illinois Wage Verification form may be verified by phone. This process helps ensure that the details are accurate and up-to-date, further supporting the integrity of the child care assistance program.

Common mistakes

Filling out the Illinois Wage Verification form can be a straightforward process, but many individuals make mistakes that could delay their childcare benefits. One common error occurs when individuals fail to provide accurate employer information. This section requires specific details such as the employer's name, address, and phone number. If any of this information is incorrect or incomplete, it can lead to significant delays in processing the form.

Another frequent mistake is not obtaining the necessary employer signature. The form explicitly states that it must be completed by the employer. Without a signature from the employer, the form is considered invalid. This oversight can result in the denial of childcare payments, which can be particularly distressing for families relying on these funds.

Additionally, individuals often overlook the importance of clearly indicating their work schedule. If the work hours vary, it is crucial to provide an example of the schedule. Failing to do so can create confusion and may lead to incorrect assumptions about the employee's availability, ultimately affecting the childcare case.

Lastly, some people neglect to read the fine print regarding the consequences of providing false information. The form warns that any fraudulent or misleading information may result in the loss of childcare payments. Understanding this can emphasize the importance of honesty and accuracy when filling out the form. Taking the time to carefully review all sections can prevent these common mistakes and ensure a smoother process.

Documents used along the form

The Illinois Wage Verification form is an essential document for individuals receiving childcare assistance. It helps verify employment and income details, which are crucial for determining eligibility for these benefits. Alongside this form, several other documents may be required to provide a complete picture of your financial situation. Here’s a brief overview of some commonly used forms that accompany the Illinois Wage Verification form.

  • Employment Verification Letter: This letter, typically provided by an employer, confirms the employee's job title, salary, and employment status. It serves as an official statement of employment and can support claims made in the Wage Verification form.
  • Pay Stubs: Recent pay stubs offer a detailed breakdown of earnings, including hourly wages, bonuses, and deductions. They provide tangible proof of income and help verify the information reported on the Wage Verification form.
  • Tax Returns: Personal tax returns, especially the most recent one, can provide a comprehensive view of an individual's annual income. They are often required to assess overall financial stability and eligibility for assistance programs.
  • Childcare Provider Information: This document includes details about the childcare provider, such as their name, address, and contact information. It is necessary for the processing of childcare payments and to ensure that the provider meets state requirements.
  • Proof of Residency: This can be a utility bill, lease agreement, or any official document showing the applicant's current address. It confirms residency and can be essential for determining eligibility for local childcare programs.

These documents work together to create a clear financial picture for the Illinois Department of Human Services. Ensuring that all forms are completed accurately and submitted on time can help avoid delays in receiving childcare assistance. Always keep copies of your documents for your records as well.

Similar forms

The Illinois Wage Verification form is a crucial document used to confirm an employee's wage information for childcare assistance. Several other documents serve similar purposes in various contexts. Here’s a look at seven documents that share similarities with the Illinois Wage Verification form:

  • W-2 Form: This form summarizes an employee's annual wages and taxes withheld. Like the Wage Verification form, it provides essential income information, but it is used primarily for tax purposes.
  • Pay Stub: A pay stub details an employee's earnings for a specific pay period. It includes information such as hourly rates, deductions, and total pay, similar to the wage information requested in the Illinois form.
  • Employment Verification Letter: This letter is issued by an employer to confirm an employee's job title, salary, and employment status. It serves a similar function in verifying income but is often used for loan applications or rental agreements.
  • IRS Form 4506-T: This form allows individuals to request a transcript of their tax return. It can verify income and tax information, much like the Illinois Wage Verification form, but is more focused on tax records.
  • Child Support Income Verification Form: This document is used to verify income for child support calculations. It requires similar wage details as the Illinois form, emphasizing the importance of accurate income reporting.
  • Loan Application Income Verification: When applying for a loan, applicants often need to provide proof of income. This requirement parallels the Illinois form's purpose of confirming wages for childcare assistance.
  • Unemployment Benefits Verification: This form is used to verify an individual's previous earnings when applying for unemployment benefits. It focuses on income verification, akin to the Illinois Wage Verification form, to determine eligibility for assistance.

Each of these documents plays a vital role in verifying income and employment status, helping individuals access various forms of assistance or fulfill legal requirements.

Dos and Don'ts

When filling out the Illinois Wage Verification form, it's important to follow specific guidelines to ensure accuracy and compliance. Here’s a list of what you should and shouldn’t do:

  • Do provide accurate information about your employment details.
  • Do ensure your employer completes the job information section.
  • Do sign the form where indicated to authorize the release of information.
  • Do double-check your case number and personal details for correctness.
  • Do return the completed form to the specified address within the 10 business days deadline.
  • Don't submit the form without your employer’s signature.
  • Don't provide false or misleading information, as this can lead to serious consequences.
  • Don't leave any required fields blank; fill in all sections completely.
  • Don't forget to keep a copy of the completed form for your records.

Misconceptions

Understanding the Illinois Wage Verification form is crucial for anyone navigating childcare assistance in the state. Unfortunately, several misconceptions surround this important document. Here are five common myths, along with clarifications to help you grasp the reality.

  • Misconception 1: The form is optional for parents.
  • This is not true. The Illinois Wage Verification form must be completed by your employer to verify your income. Without it, your childcare assistance may be delayed or denied.

  • Misconception 2: Only full-time employees need to fill out this form.
  • In reality, anyone who receives childcare assistance, regardless of their employment status—full-time, part-time, or even self-employed—must submit this form. The income verification is essential for all applicants.

  • Misconception 3: The information provided can be inaccurate without consequences.
  • Providing false or misleading information can lead to serious repercussions. If inaccuracies are discovered, you may lose your childcare payments, and your case could be canceled or denied.

  • Misconception 4: The employer's part of the form is simple and doesn't require much detail.
  • Actually, employers must provide specific details about your job, including your pay rate, work schedule, and any leave information. This thoroughness helps ensure that the verification process is accurate and efficient.

  • Misconception 5: The form can be submitted at any time.
  • This is misleading. The completed form must be returned to the specified address within 10 business days. Timeliness is crucial to avoid delays in receiving childcare assistance.

By debunking these misconceptions, you can better navigate the process and ensure that your childcare assistance application is handled smoothly. Always remember to consult with your employer and the relevant authorities if you have questions about the form or the process.

Key takeaways

When filling out and using the Illinois Wage Verification form, consider the following key takeaways:

  • Authorization Required: The form requires your signature to authorize your employer to release your wage information to the Illinois Department of Human Services.
  • Accuracy is Crucial: Providing false or misleading information can lead to serious consequences, including the loss of childcare payments.
  • Employer's Responsibility: Your employer must complete the job information section, including details such as your hourly pay rate and job title.
  • Work Schedule Details: If your work schedule varies, your employer should provide an example to clarify your typical hours.
  • Submission Deadline: The completed form must be returned to Illinois Action For Children within 10 business days.
  • Contact Information: Ensure your employer includes their contact details, as this may be necessary for verification purposes.
  • Multiple Payment Types: If you receive tips or commissions, these should be documented to reflect your total earnings accurately.

By keeping these points in mind, you can help ensure that the wage verification process goes smoothly and that your childcare case remains active.