Fill a Valid Illinois Wage Verification Template Open Editor

Fill a Valid Illinois Wage Verification Template

The Illinois Wage Verification form is a critical document issued by the State of Illinois, Department of Human Services - Bureau of Child Care and Development. It is designed to verify the income of individuals applying for childcare benefits, requiring employers to furnish details about the employee's job title, pay rate, work schedule, and more. By ensuring accurate representation of an employee's earnings and employment status, this form plays a vital role in the application process for childcare assistance.

To simplify the process of obtaining childcare benefits, make sure to accurately complete and promptly submit your Illinois Wage Verification form by clicking the button below.

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Contents

In the realm of employment verification within the State of Illinois, the Wage Verification form emerges as a pivotal document for individuals seeking childcare payments through the Department of Human Services. Designed to facilitate the process of confirming an employee's income details accurately and efficiently, this form serves as a bridge between employers and the state's Bureau of Child Care and Development. By requiring the employer to fill out specific details regarding the employee's position, including rate of hourly pay, commission, tips, and work schedule, it ensures that the Illinois Department of Human Services can verify the financial eligibility of applicants for childcare assistance. Moreover, the document underscores the seriousness of providing truthful information, alerting applicants to the consequences of submitting fraudulent, misleading, or false information, which can lead to the cancellation or denial of childcare payments. This mandatory procedure, coupled with the ease of verification by phone and the strict deadline for submission, underscores the state's commitment to supporting families in need while maintaining the integrity of the childcare assistance program.

Illinois Wage Verification Sample

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

 

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PM

 

 

 

PM

 

 

PM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

AM

 

 

 

 

AM

 

AM

 

 

AM

 

 

 

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AM

AM

 

 

 

 

PM

 

 

 

 

PM

 

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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 Details

Fact Name Detail
Form Purpose This form authorizes employers to release wage information to the Illinois Department of Human Services for verifying childcare payment eligibility.
Verification Method The information provided may be verified by phone by the Illinois Department of Human Services.
Consequences of False Information Providing fraudulent, false, or misleading information can result in the loss of childcare payments, and the childcare case may be cancelled or denied.
Information Required from Employer The form requires detailed job information including employee name, start date, pay rate, commission, tips, pay period, job title, and work schedule.
Governing Law Governed by the regulations of the Illinois Department of Human Services and applicable Illinois state laws.
Submission Details The completed form must be returned to Illinois Action For Children at the provided address within 10 business days.

Illinois Wage Verification - Usage Guidelines

Filling out the Illinois Wage Verification form is a crucial step for employees who need to verify their employment details for the Illinois Department of Human Services. This process ensures the continuity of child care payments and helps in preventing any disruptions in services. The form requires accurate and honest information from both the employee and the employer. Here are the step-by-step instructions to complete the form efficiently and correctly.

  1. Begin by reading the entire form to understand what information is needed. Pay close attention to the sections that your employer needs to complete.
  2. Under the first section labeled "WAGE VERIFICATION," write your full name to authorize your employer to release your employment information to the Illinois Department of Human Services.
  3. Enter your Client Case Number in the designated field. This number connects your form to your specific case within the Department of Human Services system.
  4. Sign your name under "Client Signature" to validate the form. Your signature indicates your consent and understanding of the document's importance.
  5. Record the date you are filling out and signing the form next to your signature.
  6. Hand the form to your employer to complete the "JOB INFORMATION" section. Ensure they fill out all fields accurately, including:
    • Employee Name
    • Start Date
    • Rate of Hourly Pay, Commission, and Tips (if applicable)
    • Pay Period with the appropriate box checked (Weekly, Bi-Weekly, Twice Per Month, Monthly)
    • Employee Job Title and information about payment in cash
    • Details regarding any leave (If applicable)
  7. Instruct your employer to provide a sample work schedule in the "WORK SCHEDULE" section. They should mark the hours for each day and specify if these hours vary.
  8. Confirm that the employer has included the Employer/Company Name, Employer Address, City, and Employer Phone Number for verification purposes.
  9. The employer must print their name and title, then sign and date the form in the provided spaces.
  10. Review the form to ensure all sections are completed and the information is accurate.
  11. Finally, either you or your employer must send the form to Illinois Action For Children at the address provided on the form within 10 business days. The address is 1340 South Darren Avenue, 3rd Floor, Chicago, IL 60608.

After submitting the form, it's a good idea to keep a copy for your records. The Illinois Department of Human Services or Illinois Action For Children may contact your employer to verify the information. Ensuring the form is completed accurately and submitted promptly will help in maintaining any childcare payments you receive and avoid potential interruptions in service.

Get Answers on Illinois Wage Verification

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

  2. The Illinois Wage Verification form is designed to confirm an employee's wage information with their employer. This verification assists the Illinois Department of Human Services, particularly the Bureau of Child Care and Development, in determining eligibility for various programs, including childcare assistance. By completing this form, employers provide essential details about an employee's pay rate, schedule, and job title, ensuring accurate and fair assessment for childcare payments.

  3. Who needs to complete the Illinois Wage Verification form?

  4. The form must be filled out by the employer at the request of an employee participating or applying for childcare payment assistance through the Illinois Department of Human Services. It’s the employee’s responsibility to authorize the release of this information by signing the form, but the detailed job and wage information must be provided by the employer.

  5. What happens if the information provided on the form is false or misleading?

  6. If any information provided on the form is found to be fraudulent, false, or misleading, there could be serious consequences. The employee may lose their childcare payments, and their case might be cancelled or denied. It's crucial for both employees and employers to ensure that all information provided is accurate and truthful.

  7. What types of compensation details need to be disclosed on this form?

  8. Employers are required to disclose several types of compensation details for the employee, including their rate of hourly pay, any commissions, and average monthly tips. This comprehensive information helps the Department of Human Services make an accurate assessment of an employee’s earnings for childcare benefits eligibility.

  9. How does an employer submit the completed Illinois Wage Verification form?

  10. Once an employer has filled out the required information on the form, it should be returned to Illinois Action for Children at the address provided on the form. The employer needs to ensure that the completed form is sent within 10 business days to the specified address:

    Illinois Action For Children
    1340 South Damen Avenue, 3rd Floor
    Chicago, IL 60608

  11. What if an employee's work schedule varies?

  12. If an employee's work schedule is not consistent, the employer needs to provide an example of the varying schedule on the form. Additionally, the employer should explain any fluctuations in the hours worked, offering clarity on the typical patterns or conditions that account for the variance.

  13. Are employers required to indicate if an employee is paid in cash?

  14. Yes. The form specifically asks whether the employee is paid in cash. It's important for employers to accurately disclose the method of payment, as this information could affect the verification process and eligibility assessment for childcare assistance.

Common mistakes

Completing the Illinois Wage Verification form accurately is crucial for ensuring that child care payments are processed efficiently and without unnecessary delay. However, individuals often encounter pitfalls during the filing process. By understanding and avoiding these common mistakes, employees and employers can both contribute to a smoother process.

  1. Not providing complete employer information: One common mistake is omitting details like the full name of the employer, address, or contact number. This oversight can lead to delays in form processing.
  2. Incorrectly reporting pay rate or schedule: Misrepresenting or inaccurately stating the rate of hourly pay, commission, or tips can cause discrepancies that may require clarification, further delaying the process.
  3. Failing to indicate the correct pay period: Employees must accurately check whether they are paid weekly, bi-weekly, twice per month, or monthly. Incorrect selections here can lead to confusion regarding the calculation of income.
  4. Omitting job title or incorrectly reporting job status: Not providing a job title or misinforming about current employment status, such as being on leave without mentioning the return date or type of leave, compromises the form’s accuracy.
  5. Incomplete work schedule details: For those whose schedules vary, it is essential to provide a clear example of the work schedule. Failing to do this or to indicate that the schedule varies can lead to incorrect assumptions about availability and income.
  6. Not specifying if payment is in cash: There’s a specific inquiry to declare if the employee is paid in cash. Overlooking or failing to answer this question can raise queries from the Department of Human Services.
  7. Leaving the client signature, case number, or date blank: The form requires the client’s (employee’s) signature, case number, and date at the top. Skipping any of these elements can result in the immediate return of the document.
  8. Delay in returning the completed form: The form must be returned to the specified address within 10 business days. Procrastination in sending the completed verification might lead to a denial or cancellation of childcare payments.

To avoid these mistakes, both employees and employers are encouraged to review the form together, if possible, and ensure that all provided information is complete, accurate, and submitted in a timely manner. Attention to detail can significantly streamline the verification process, benefitting all parties involved.

Documents used along the form

When navigating through the seemingly intricate process of verifying employment and wages in Illinois, especially within the context of securing child care benefits, understanding the landscape of required forms and documentation is crucial. Besides the primary Illinois Wage Verification form, multiple other documents often play a pivotal role, ensuring a smoother verification process and adherence to regulations. Here's a look at some of these essential documents:

  • Employment Verification Letter: This document is a formal communication from an employer confirming an individual's employment status, job title, salary, and often, the employment period. It serves as proof of income and employment stability.
  • Pay Stubs: Pay stubs are an employee's record of earnings for a given pay period. They detail gross income, deductions (such as taxes and retirement contributions), and net income. Pay stubs corroborate the information provided on the Illinois Wage Verification form.
  • Form W-2: Issued annually by employers, the W-2 form reports an employee's annual wages and the amount of taxes withheld from their paycheck. It is vital for verifying annual income and tax compliance.
  • Form 1099: For individuals who are self-employed or independent contractors, the 1099 form reports non-employment income. This form is essential for verifying income for those who may not have traditional pay stubs or W-2 forms.
  • Bank Statements: Bank statements can serve as supplementary evidence of income, especially for self-employed individuals or in cases where pay varies significantly from month to month. They show cash flow and can support other forms of income documentation.
  • Proof of Childcare Expenses: While not directly related to wage verification, proof of child care expenses is often required to determine the amount of assistance or subsidy an applicant is entitled to. Receipts or contracts from childcare providers are commonly used for this purpose.
  • Employment History Report: An employment history report from the Social Security Administration can provide an overview of an individual's employment history and earnings over the years. This report can be useful for verifying long-term employment and income history.

Each of these documents plays a crucial part in painting a full picture of an individual's employment and income situation. Together with the Illinois Wage Verification form, they form the backbone of the verification process, ensuring that accurate and fair decisions can be made in relation to child care support and other related services. Remember, the goal of gathering these documents is not just to fulfill procedural requirements but to ensure that every family has access to the support they need, based on accurate and fair assessment of their circumstances.

Similar forms

The Illinois Wage Verification form is similar to other documents used for verifying employment details and wage information. Among these, notable ones include the Federal I-9 Employment Eligibility Verification form and the Employment Verification Letter. Each plays a crucial role in official and organizational procedures, confirming various aspects of a person's employment status and earnings.

The Federal I-9 Employment Eligibility Verification form is a document that all U.S. employers must complete for each individual they hire for employment in the United States. This form is akin to the Illinois Wage Verification form in its purpose of validating information about an employee. However, the I-9 focuses specifically on verifying the employee’s identity and legal authorization to work in the U.S. It requires documentation such as a passport, driver’s license, or birth certificate, unlike the Illinois form which mainly collects details about wages, employment period, and job role.

An Employment Verification Letter, on the other hand, serves a broader purpose but is similar in its objective to confirm employment details. This letter, typically issued by an employer or a human resources department, outlines an employee’s position, salary, and employment dates. Similar to the Illinois Wage Verification form, it may be used to verify income information for various purposes like loan applications or rental agreements. However, unlike the standardized form, an employment verification letter is more customizable and can provide a detailed narrative or summary of the employee's job and compensation, including any bonuses or additional benefits.

Dos and Don'ts

When completing the Illinois Wage Verification form, it's essential to pay attention to details and follow the instructions carefully. This form serves as a critical piece of documentation for verifying employment and wage details for various purposes, including applying for or maintaining childcare assistance through the Illinois Department of Human Services. Here is a list of dos and don'ts to guide you through the process effectively and accurately:

  • Do ensure that all information provided is accurate and truthful to avoid any potential for fraud or misinformation.
  • Do carefully review the entire form before starting to fill it out to understand all the required fields and information.
  • Do use a pen with black or blue ink when filling out the form, unless it is being completed electronically.
  • Do provide detailed and specific information about the work schedule, including an example schedule if hours vary, to give a clear understanding of the employment situation.
  • Do confirm the employer’s details, such as the company name, address, and phone number, are current and correct.
  • Do double-check that both the employee and employer sections are completed fully by the respective parties.
  • Do not leave any required fields blank. If a section does not apply, mark it as “N/A” (not applicable).
  • Do not forget to sign and date the form in the designated client (employee) section to authorize the release of wage information.
  • Do not attempt to fill out the employer part of the form unless you have been explicitly authorized to do so.
  • Do not delay in returning the completed form to the specified address within 10 business days to avoid any processing delays.

Following these guidelines will help ensure that the Illinois Wage Verification form is completed accurately and efficiently, supporting a smooth process for verifying employment and wage information.

Misconceptions

Many people hold misconceptions about the Illinois Wage Verification form, which can lead to confusion and errors in the childcare payment process. Understanding the purpose and requirements of this form is crucial for anyone employed in Illinois who seeks childcare assistance.

  • It can be completed by the employee: This is incorrect. The form clearly states that it is to be filled out by the employer only. The employee's involvement is limited to authorizing the employer to release their wage information to the Illinois Department of Human Services.
  • Verbal verification is not an option: Actually, the form does mention that the information provided may be verified by phone. This ensures that any discrepancies can be clarified and corrected in a timely manner.
  • Fraudulent information has no real consequences: On the contrary, the form explicitly warns that providing false, fraudulent, or misleading information could lead to the loss of childcare payments, and the child care case may be cancelled or denied.
  • The form must be mailed: Though the form provides a mailing address, it doesn't specify that mailing is the only return method. It's important to follow any additional instructions provided by Illinois Action for Children or the Department of Human Services regarding submission.
  • All employees have the same pay period options: The form actually allows for different pay period frequencies, such as weekly, bi-weekly, twice per month, or monthly, to accommodate varying employment agreements.
  • Direct deposit payments do not need to be reported: There is a common misconception that only hard cash payments need to be declared. However, the form does not distinguish between cash and other forms of payment; all earnings, including direct deposits, must be reported.
  • Leave details are irrelevant if not currently on leave: Even if an employee is not currently on leave, providing information on potential leave types and return date expectations is necessary for a comprehensive understanding of the employee's working arrangements and anticipated childcare needs.

Dispelling these misconceptions ensures that employees accurately complete the Illinois Wage Verification form, thereby securing their eligibility for childcare payments without undue delays or complications.

Key takeaways

Filling out the Illinois Wage Verification form is an integral step for individuals seeking childcare assistance through the Illinois Department of Human Services. This form plays a crucial role in determining your eligibility and the amount of assistance you may receive. Here are nine key takeaways to ensure the process is handled accurately and efficiently:

  • Authorization is vital: By signing the form, you're authorizing your employer to release your employment and wage information to the Illinois Department of Human Services. This step is crucial for the verification process.
  • The form should be completed by your employer. It's your responsibility to provide the form to your employer, but they must fill out the sections pertaining to job information and work schedule.
  • Accuracy is key when reporting earnings and work schedule. This includes your rate of hourly pay, commissions, tips, and the frequency of your pay (weekly, bi-weekly, etc.).
  • Clarity on cash payments: The form specifically asks if the employee is paid in cash. Being transparent about this can affect the determination process of your childcare assistance application.
  • Details on your work schedule need to be comprehensive. If your schedule varies, providing a typical example of your workweek is necessary. Any variations should be explained clearly.
  • The form requires information about any leave of absence, including the type of leave and the return date. This information may impact your eligibility or the level of assistance provided.
  • Employer verification is a must. Your employer’s signature, along with the company’s name, address, and phone number, serves as a validation of the information provided.
  • This form must be returned to Illinois Action for Children, not directly to the Department of Human Services. The address is provided on the form, emphasizing the correct destination for submission.
  • The form specifies a deadline for submission: within 10 business days from the time it's given to your employer. Adhering to this timeline is important to avoid delays in your application process.

Understanding and following these key points can streamline the process of verifying your wage for childcare assistance applications. It's essential to collaborate closely with your employer to ensure the form is completed correctly and submitted on time. The accuracy and timeliness of this information can significantly impact the outcome of your assistance request.

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