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Fill a Valid Illinois Income Verification Template

The Illinois Income Verification form is a document that must be completed with the assistance of an employer, to verify the income of an individual seeking assistance from Illinois Action for Children. It is a crucial step in the initial eligibility process for various support services, requiring detailed employment and income information to ensure accurate verification. Ensuring this form is filled out accurately and submitted on time is essential for individuals to receive the assistance they need.

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In the State of Illinois, the process of applying for or maintaining eligibility for certain benefits requires a thorough and accurate demonstration of one’s income. Among the essential documents facilitating this process is the Illinois Income Verification form, a crucial piece of paperwork designed to transparently communicate an applicant's financial circumstances to Illinois Action for Children. Located at 1340 S Damen Avenue, Chicago, and effective since August 10, 2006, this document serves a dual purpose: initially, to establish eligibility for benefits and subsequently, to aid in the redetermination of said eligibility. It necessitates detailed information from both the applicant and their employer, covering aspects such as the employer’s business details, the nature of the employment, the employee's work schedule, earnings, and additional income such as tips or commissions. The form underscores the importance of accuracy and verifiability, mandating signatures from both the employee and the employer to attest to the truthfulness of the provided information. An explicit authorization by the employee permits the employer to release their income details to the facilitating organization, emphasizing the collaborative approach towards maintaining compliance and transparency in the eligibility process for child related benefits in Illinois.

Illinois Income Verification Sample

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 Details

Fact Detail
Document Title Income Verification
Document Reference CCAP_IV.doc rev. 8/10/2006
Address for Submission 1340 S Damen Avenue 3rd Floor, CHICAGO, IL 60608
Purpose For initial eligibility purposes for clients applying to Illinois Action for Children services

Illinois Income Verification - Usage Guidelines

Filling out the Illinois Income Verification form is a crucial step towards ensuring your initial eligibility for certain benefits or services. This document serves as a key piece of evidence to verify your income through your employer. It’s important to complete this form accurately and thoroughly to avoid any delays or issues with your application. The process involves both you and your employer, each with distinct sections to fill out. Below are the steps to properly complete the Illinois Income Illinois Verification form.

  1. Begin with the section titled "TO BE FILLED OUT BY CLIENT." Write your full name as "Client's Name" and ensure it matches the name on your official documents.
  2. Enter your Case Number if you have one. If you're unsure, leave it blank or contact Illinois Action for Children for guidance.
  3. In the section labeled "Employee’s Name," fill in your name again to authorize your employer to release the required income information.
  4. Read the declaration below carefully, understanding that this form is for establishing initial eligibility and future verifications may be requested. Sign your name under "Employee’s Signature" and write the date next to it.
  5. Hand over the form to your employer to complete the next section.
  6. "TO BE FILLED OUT BY EMPLOYER" - Your employer should now fill in the business information starting with the "Name of business" if applicable, followed by the type of business or work you perform.
  7. The employer should write the "Name of business owner or employer," the "Business address," and the "Business phone" number including area code.
  8. "Start date of current employment" requires the date you started working for this employer.
  9. The employer must indicate the "Actual—or average—number of hours worked by the employee per week."
  10. Next, how you are paid should be specified (Cash, Personal check, Payroll check, Other) along with the frequency of payment (Weekly, Biweekly, Semi-monthly, Monthly).
  11. The "gross amount of $ per pay period" should be entered. If this amount varies, an average should be provided.
  12. Your "gross hourly wage" must be noted, as well as any "weekly tips or commissions."
  13. The employer should describe your typical work schedule, clearly marking the start and end times for each day you work, and indicating AM or PM.
  14. After reviewing the information for accuracy, your employer will sign under "Business Owner or Employer's Signature," date it, and provide their SSN/FEIN and phone number.
  15. Finally, submit the completed form to the specified address or as directed by Illinois Action for Children.

Once the Illinois Income Verification form is filled out and submitted, it will be processed to verify your income details as part of your eligibility assessment. It’s important to ensure that all provided information is accurate and true to avoid potential delays. Following these steps carefully will help make the process smoother for both you and your employer.

Get Answers on Illinois Income Verification

  1. What is the purpose of the Illinois Income Verification form?

    The Illinois Income Verification form is designed to confirm an employee's income details as part of initial eligibility determination for services provided by Illinois Action for Children. It is a necessary step to assess whether an individual qualifies for certain support or assistance programs based on their income levels. This form must be completed with information from both the client and their employer and is submitted alongside additional proof of income during the Redetermination process.

  2. Who needs to fill out the Illinois Income Verification form?

    Two parties are required to fill out the form: the client seeking eligibility for services and the employer of the said client. The client section authorizes the employer to release income information to Illinois Action for Children and acknowledges the requirement for further documentation. The employer section provides detailed information about the client’s employment status, income, and work schedule.

  3. What information must the employer provide on the Illinois Income Verification form?

    Employers are asked to supply details regarding the business or work performed, including the business name, address, and phone number, as well as the business owner’s or employer’s name and contact details. Additionally, the form requires information about the start date of the client's current employment, average hours worked per week, payment method, payment frequency, gross pay per period, gross hourly wage, and any tips or commissions earned. An accurate work schedule for a typical week must also be provided.

  4. How does an employer indicate the employee’s pay frequency and method?

    On the income verification form, employers must select the appropriate options to indicate how the employee is paid. For payment frequency, the choices include weekly, biweekly, semi-monthly, and monthly. For the method of payment, the options are cash, personal check, payroll check, or other, with a prompt to specify if another method is used.

  5. Is it mandatory for the employee to sign the Illinois Income Verification form?

    Yes, it is mandatory for the client (employee) seeking eligibility review to sign the Illinois Income Verification form. The employee’s signature authorizes the employer to release employment and income information to Illinois Action for Children and confirms the client's understanding that this is part of the process for initial eligibility purposes. Without this signature, the form is considered incomplete and the verification process cannot proceed.

  6. What should an employer do if an employee’s income varies?

    If an employee's income varies, for instance, due to fluctuating hours, seasonal work, or commission-based roles, the employer is instructed to provide an average amount for the employee’s gross pay per period. This average should be calculated based on recent pay periods to ensure an accurate representation of the employee’s earnings.

  7. Can the form be submitted electronically to Illinois Action for Children?

    The details regarding electronic submission can vary based on the current policies of Illinois Action for Children and the availability of secure electronic submission channels. Generally, employers and clients should check directly with Illinois Action for Children for the most up-to-date submission guidelines, including whether the form can be faxed or must be sent through another secure means.

  8. What are the consequences of providing false information on the Illinois Income Verification form?

    Providing false information on the Illinois Income Verification form is considered fraud and has serious consequences. These consequences may include denial of benefits, repayment of benefits received based on inaccurate information, and possible legal action. Both employees and employers are urged to ensure that all information provided on the form is true and correct to the best of their knowledge.

Common mistakes

When filling out the Illinois Income Verification form, it is crucial to avoid common mistakes that can lead to processing delays or issues with your application. Below are nine frequent errors:

  1. Not ensuring the employer signs the form. The form explicitly requires the employer's signature for authenticity and verification purposes.
  2. Failing to authorize the release of information by neglecting to sign the form as the client. Client consent is necessary for the process to proceed.
  3. Omitting the case number or employee’s name, which are critical for matching the form to the correct file in the system.
  4. Providing inaccurate or incomplete employer information, such as the business address or phone number, hindering communication and verification efforts.
  5. Skipping the employment start date or inaccurately reporting the number of hours worked per week can lead to incorrect determinations of eligibility.
  6. Selecting the incorrect payment method or frequency, which affects the calculation of your income.
  7. Inaccurately reporting wages, tips, or commissions, either by underreporting or overreporting amounts, leading to potential discrepancies in the eligibility assessment.
  8. Leaving the work schedule blank or circling both “a.m.” and “p.m.” without specifying accurate work hours can cause confusion.
  9. Forgetting to include the employer’s Social Security Number (SSN) or Federal Employer Identification Number (FEIN), which is necessary for validating the employer's identity and business.

Avoiding these mistakes requires careful review of the form and clear communication with your employer to ensure all provided information is accurate and complete. By doing so, you can help ensure a smoother verification process.

Documents used along the form

When it comes to understanding the administrative side of employment and government assistance in Illinois, the Income Verification form is just the start. People often find themselves needing additional forms and documents to fully comply with various program requirements or employment processes. Here’s a closer look at some documents that frequently accompany the Illinois Income Verification form, each serving a pivotal role in ensuring accuracy and compliance within the framework of financial and employment verification processes.

  • W-2 Form: This crucial tax document is issued by employers to report an employee's annual earnings and taxes withheld. It’s often required to corroborate the income reported on the Income Verification form.
  • Pay Stubs: Recent pay stubs provide a detailed breakdown of an employee's earnings, including hours worked, gross pay, net pay, and deductions. They serve as proof of current employment and income level.
  • Employment Verification Letter: Sometimes, an employer may issue a letter to verify a person's employment status, job title, salary, and employment dates. Such letters can provide additional context or verification needed beyond the Income Verification form.
  • Bank Statements: Bank statements help to confirm the income an individual reports by showing deposits, expenditures, and the financial health of an individual’s accounts over a specific period.
  • Tax Return Documents: For self-employed individuals or those needing to provide proof of income from the previous year, tax return documents (like the Form 1040) are essential.
  • Unemployment Benefits Documentation: For individuals currently receiving unemployment benefits, documentation or letters from the state unemployment office can verify income sources aside from employment.
  • Social Security Benefits Statements: These statements are critical for individuals who receive income from Social Security, providing proof of these benefits as part of their total income.
  • Worker’s Compensation Letters: For those receiving worker’s compensation, official letters or documentation can verify these benefits as a part of the individual’s income.
  • Child Support Agreement Documents: Legal documents outlining child support arrangements (including amounts and schedules) are necessary to verify this aspect of an individual’s financial responsibilities and resources.
  • Rental Income Documentation: For individuals earning money from rental properties, documents that confirm this income, such as lease agreements and bank statements showing rent payments, are essential.

Navigating the requirements for employment or assistance programs in Illinois can feel overwhelming with the array of forms and documents needed. However, understanding the purpose and use of each of these documents can significantly streamline the process. Whether it's solidifying your income with pay stubs and tax documents, or providing evidence of additional income sources like rental payments or child support, each document has its unique role in painting a comprehensive picture of an individual's financial landscape.

Similar forms

The Illinois Income Verification form shares similarities with several other documents commonly used within the scope of employment and financial verification processes. While its purpose is geared specifically towards confirming an individual’s income for childcare assistance programs, its structure and requested information echo those found in other forms. This resemblance underscores the standardized nature of income verification across different contexts.

IRS Form W-2, Wage and Tax Statement: At first glance, the Illinois Income Verification form and the IRS Form W-2 might not seem alike, given their different end purposes. However, a closer inspection reveals a common objective: both seek to document an individual’s earnings. The W-2, mandated for employees annually, outlines the total income and taxes withheld. Similarly, the Illinois form requires details on the employee's wages, although it focuses on current earnings and is used for a specific eligibility determination. Both forms necessitate employer verification, reinforcing the authenticity of the reported income.

Pay Stubs: Pay stubs are not formal forms like the Illinois Income Verification form; however, they serve a parallel purpose in the realm of income documentation. Pay stubs detail an employee's earnings for a specific pay period, including gross wages, taxes, and other deductions. The Illinois form asks for similar details, such as the employee’s gross amount per pay period and hourly wage, highlighting the form's necessity for verifying income with a granular level of detail. Different from the Illinois form, pay stubs are typically generated every pay period and automatically include many of the earnings details that the form seeks to confirm through employer verification.

Employment Verification Letter: This document is closely related to the Illinois Income Verification form in terms of functionality. Often required by lenders, landlords, or government agencies, an employment verification letter confirms an employee’s position, salary, and employment status. While the letter provides a summary of an employee’s income and employment, similar to the outlined expectations on the Illinois form, it is usually less structured and can vary in the breadth of information provided. This contrast in format highlights the Illinois form’s specific design to meet the requirements of the Illinois Action for Children program, demonstrating a focused approach compared to the broader application of a standard employment verification letter.

Dos and Don'ts

Completing the Illinois Income Verification form accurately is essential for ensuring your eligibility for certain services. For a smoother process, here are some helpful guidelines on what you should and shouldn overdo:

What You Should Do:

  • Review all sections carefully before you begin to ensure you understand what information is required.
  • Gather all necessary documents related to your employment and income beforehand to make the process as accurate and efficient as possible.
  • Ensure your employer signs the form, as it's a mandatory requirement for the form’s submission and subsequent processing.
  • Be accurate when detailing your work schedule and income. Estimations should be avoided unless absolutely necessary, and even then, they should be as close to exact as possible.
  • Keep a copy of the completed form for your records before submitting it to Illinois Action for Children. This can be helpful for future reference or if any questions arise.
  • Submit additional proof of income when requested. Remember, this form is for initial eligibility, and further documentation will be crucial for continued support.

What You Shouldn't Do:

  • Leave sections blank. If a section does not apply to you, write “N/A” instead of leaving it empty. This clarifies that you didn't overlook the section.
  • Guess on numbers. Whether it’s your income, hours worked, or tips earned, providing accurate figures is critical.
  • Submit the form without your signature or the date. The form is considered incomplete and won't be processed without this.
  • Forget to check for your employer’s signature and information, including their SSN/FEIN, which is necessary for verification purposes.
  • Ignore instructions for encircling “a.m.” or “p.m.” for your typical work schedule. This small detail is important for clarity.
  • Omit contact details for both yourself and your employer. Accurate phone numbers and addresses facilitate necessary follow-up and verification.

By following these dos and don'ts, you'll help ensure that your Illinois Income Verification form is filled out correctly and efficiently, thereby avoiding delays or complications in the processing of your form. Accuracy, completeness, and consistency with the required information are key factors in streamlining the process for all parties involved.

Misconceptions

There are several misconceptions about the Illinois Income Verification form that often confuse individuals and employers alike. Clarifying these misunderstandings can help ensure the form is filled out accurately and promptly, aiding in the timely processing of applications.

  • Misconception 1: The form is only for the self-employed. This is incorrect as the form must be completed by all employees seeking income verification, not solely by those who are self-employed. It is designed to verify income sources for various purposes, including eligibility for certain programs.
  • Misconception 2: Employer’s personal information is not required. In fact, the form requires the business owner or employer’s signature, business address, and either Social Security Number (SSN) or Federal Employer Identification Number (FEIN), ensuring that the information provided is traceable and verifiable.
  • Misconception 3: The form is valid without the employer’s signature. Every form must be signed by the employer to certify that the reported information is accurate. This is a crucial step for the verification process.
  • Misconception 4: Digital signatures are not accepted. Given the advancements in digital communication and the need for efficient document processing, digital signatures from employers are indeed accepted, provided they comply with the legal standards for such signatures.
  • Misconception 5: It's unnecessary to specify the type of payment. On the contrary, the form requires clarification on whether the employee is paid by cash, personal check, payroll check, or another method. This detail is important for a complete understanding of the employee’s payment arrangement.
  • Misconception 6: Tips or commissions should not be included in the income. The form explicitly asks for the inclusion of estimated weekly tips or commissions as these directly contribute to the gross income, affecting eligibility for programs requiring income verification.
  • Misconception 7: The form is only for initial eligibility determinations. While the document mentions its use for initial eligibility, it also indicates that additional proof of income will be required at the time of redetermination, illustrating its ongoing role in verifying income levels.

Understanding these points helps ensure that both employees and employers can complete the Illinois Income Verification form correctly, thereby smoothing the path towards accurate and efficient income verification. It is always recommended to read the instructions carefully and provide thorough and precise information to prevent delays or issues in the verification process.

Key takeaways

When filling out the Illinois Income Verification form, individuals should be aware of several critical aspects to ensure accuracy and compliance. Below are key takeaways highlighted to assist in the process:

  • Employer Participation is Mandatory: The form requires the employer's signature to verify the employee's income. This means that communicating with your employer and ensuring they complete their portion accurately is essential.
  • Personal and Employment Information: Both the employee and employer must fill out specific sections. The employee authorizes the release of income information, while the employer provides detailed employment data, including payment frequency, gross wages, and work schedule.
  • Accuracy is Crucial: It's imperative to provide accurate and truthful information. The employer is asked to verify that the information they provide is correct to the best of their knowledge, which underscores the importance of precision.
  • Use for Initial Eligibility and Redetermination: This form is used not only for assessing initial eligibility for Illinois Action for Children services but also for future income verifications at the time of redetermination. It highlights the need for ongoing accuracy and updates in employment and income status.

Understanding these key points can help streamline the process and ensure that applicants submit the form correctly, thereby avoiding delays or issues with service eligibility.

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