Get Illinois Boa 4 Form

The Illinois BOA-4 form is a Financial Information Statement for Individuals, used to gather personal and financial details. This form helps the Illinois Department of Revenue assess an individual's financial situation, including income, expenses, and assets. To get started on your financial assessment, fill out the form by clicking the button below.

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The Illinois BOA-4 form is a crucial document for individuals seeking financial assistance or relief from the state. This form gathers detailed financial information to assess an individual's or couple's financial situation. It consists of several sections, starting with personal details such as marital status, employment history, and income sources. Individuals must provide their average monthly take-home pay and any deductions from their paycheck. The form also requires information about bank accounts, credit cards, real estate, and insurance policies. Additionally, it includes sections for listing assets and liabilities, which helps in understanding the overall financial picture. By completing the BOA-4 form accurately, individuals can ensure that their financial needs are assessed fairly and that they receive the appropriate support from the state. This article will explore the key components of the form, the importance of each section, and tips for completing it effectively.

Document Breakdown

Fact Name	Fact Description
Form Title	Illinois Department of Revenue BOA-4 Financial Information Statement for Individuals
Governing Law	This form is authorized under the Illinois Income Tax Act.
Purpose	The BOA-4 form collects financial information from individuals for tax purposes.
Marital Status	Individuals must indicate their marital status: single, married, or separated.
Employment Information	Section 1 requires details about the individual's employment and income.
Spousal Information	If married, the form requires additional information about the spouse.
Financial Disclosure	Part 2 requests detailed financial information, including bank accounts and liabilities.
Signature Requirement	Signatures of both the petitioner and spouse are required under penalties of perjury.
Processing Consequences	Failure to provide required information may result in the form not being processed.
Form Version	The current version of the form is BOA-4 (R-4/01).

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Misconceptions

Misconception 1: The BOA-4 form is only for individuals who are unemployed.

This form is designed for all individuals, regardless of employment status. Whether employed, unemployed, or retired, everyone must provide their financial information.

Misconception 2: You do not need to include your spouse’s information if you are married.

If you are married, it is essential to complete your spouse's information in Part B of the form. This information is necessary for a complete financial assessment.

Misconception 3: The form only requires information about bank accounts.

In addition to bank accounts, the BOA-4 form asks for details about charge cards, real property, insurance policies, and other securities. All financial aspects must be reported.

Misconception 4: You can leave sections blank if you do not have certain assets.

It is important to fill out all applicable sections. If you do not have certain assets, indicate that clearly, rather than leaving sections blank.

Misconception 5: The BOA-4 form is optional for financial disclosures.

This form is required under the Illinois Income Tax Act. Failing to provide complete information may result in delays or issues with processing.

Misconception 6: You can submit the form without signing it.

Both the petitioner and the spouse must sign the form. Signatures confirm that the information provided is accurate and complete.

Example - Illinois Boa 4 Form

Illinois Department of Revenue

BOA-4 Financial Information Statement for Individuals

Section 1: Tell us about yourself and your employment

Part A: Your information

1	Marital status		single	married	separated
	If married, complete your spouse’s information in Part B.
2	Your name ___________________________________________ 11						Filing status	single	married filing jointly
3 Street address ________________________________________								head of household	married filing separately
	____________________________________________________ 12						Average monthly take-home pay $___________________________
	City			State	ZIP	13	Amounts withheld from your paycheck (e.g., savings, bonds,
						13	Amounts withheld from your paycheck (e.g., savings, bonds,
4	Home phone (____)____________________________________						deferred amounts, car payments, etc.) $______________________
5	Social Security number		___ ___ ___- ___ ___- ___ ___ ___ ___				______________________________________________________
6	Unemployed	yes	no If “yes,” how long. _______________ 14				Dates paid _____________________________________________
7	Current or former employer’s name ________________________ 15						Length of employment ____________________________________
8	Address _____________________________________________ 16						Date of birth	___ ___/___ ___/___ ___ ___ ___
	____________________________________________________ 17						Name and address of next of kin (other than spouse)
	City			State	ZIP		Name ________________________________________________
							Name ________________________________________________
9	Work phone (_____)____________________________________						Street address _________________________________________
10	Occupation___________________________________________						______________________________________________________
							City		State	ZIP

Part B: Your spouse’s information

18	Spouse’s name _______________________________________ 25					Work phone(_____)______________________________________
19	Address (if different)____________________________________ 26					Occupation ____________________________________________
	____________________________________________________ 27					Average monthly take-home pay $___________________________
	City		State	ZIP	28	Amounts withheld from your paycheck (e.g., savings, bonds,
					28	Amounts withheld from your paycheck (e.g., savings, bonds,
20	Home phone (if different)(_____)__________________________					deferred amounts, car payments, etc.) $______________________
21	Social Security number		___ ___ ___-___ ___-___ ___ ___ ___			______________________________________________________
22	Unemployed	yes	no If “yes,” how long._______________ 29			Dates paid _____________________________________________
23	Current or former employer’s name ________________________ 30					Length of employment ____________________________________
24	Address _____________________________________________ 31					Date of birth ___ ___/___ ___/___ ___ ___ ___
	____________________________________________________
	City		State	ZIP

Section 2: Complete the following financial information

Note: Attach additional sheets in the same format for any of the following parts if necessary.

Part A: Your bank accounts (include savings and loans, credit unions, IRA and retirement plans, and certificates of deposit)

	A	B	C	D	E
			Type of	Account
	Name of institution	Address	account	number	Balance
32	______________________	_______________________________________	___________	___________	____________
33______________________		_______________________________________	___________	___________	____________
34	______________________	_______________________________________	___________	___________	____________
35	______________________	_______________________________________	___________	___________	____________
36	______________________	_______________________________________	___________	___________	____________
37______________________		_______________________________________	___________	___________	____________
38	Add Lines 32 through 37, Column E, and write the total here and on Part G, Line 56, Column B.			38	____________

BOA-4 (R-4/01)

Page 1 of 4

Part B: Your charge cards or credit lines from your banks, credit unions, and savings and loans

	A	B	C
	Type of account		Current
	or card	Name and address of financial institution	balance
39	_________________	_______________________________________________________________________	___________
40	_________________	_______________________________________________________________________	___________
41	_________________	_______________________________________________________________________	___________
42	_________________	_______________________________________________________________________	___________
43	_________________	_______________________________________________________________________	___________
44	Add Lines 39 through 43, Column C, and write the total here and on Part G, Line 57, Column C.		44 ___________

Part C: Real property you own

	A	B	C	D
	Brief description	How property
	of property	is titled	Physical address	County
45	_____________________________	__________________	_______________________________________	___________
46	_____________________________	__________________	_______________________________________	___________
47	_____________________________	__________________	_______________________________________	___________

Part D: Your life and health insurance policies

	A	B	C	D	E
		Policy		Face	Available
	Insurance company	number	Type	amount	loan value
48	__________________________________________________	___________	___________	___________	___________
49	__________________________________________________	___________	___________	___________	___________
50	Add Lines 48 and 49, Column E, and write the total here and on Part G, Line 60, Column B.				50 ___________

Part E: Your securities (e.g., stocks, bonds, annuities, mutual funds, money market funds, government securities, notes, personal, etc.)

	A	B	C	D	E
	Type			Quantity or
	of security	Location	Owner of record	denomination	Present value
51	_________________	______________________________	_________________________	___________	___________
52	_________________	______________________________	_________________________	___________	___________
53	Add Lines 51 and 52, Column E, and write the total here and on Part G, Line 61, Column B.				53 ___________

Part F: Miscellaneous information

54a Are foreclosure, bankruptcy, receivership, or assignment for benefit of creditors proceedings pending? b What is the bankruptcy number? ______________________

Yes

c What date was the bankruptcy filed? ___ ___/___ ___/___ ___ ___ ___			If closed, what was the date? ___ ___/___ ___/___ ___ ___ ___
Month	Day	Year	Month	Day	Year

Page 2 of 4

BOA-4 (R-4/01)

Part G: Analyze your assets and liabilities

Note: Write amounts in all unshaded areas that apply

	A	B
		Fair market
	Description	value
55	Cash	___________
56	Total bank accounts
	from Section 2, Part A,
	Line 38	___________

57Total charge cards balance from Section 2, Part B,

Line 44

___________

58Vehicles (model, year)

a ___________________		___________
b ___________________		___________
c ___________________		___________
59	Real property listed
	in Section 2,
	Part C, (Line 45)	___________
	(Line 46)	___________
	(Line 47)	___________
60	Total cash or loan value
	of insurance from
	Section 2, Part D,
	Line 50	___________
61	Total securities from
	Section 2, Part E,
	Line 53	___________
62	Other assets (specify)

Liabilities

balance due

___________

Equity

(Column B minus

Column C)

___________

Monthly payment amount

___________

Pledgee or obligee

___________________

Date of

final

payment

____________

a___________________

b___________________

c___________________

63 Other liabilities not covered above (e.g., judgments, charities, tuition)

a___________________

b___________________

c___________________

64 Federal taxes owed

65 State taxes owed a Illinois individual

income tax

b Illinois business income tax

c Other state taxes

66Total

___________

___________________

____________

BOA-4 (R-4/01)

Page 3 of 4

Part H: Analyze your monthly income and expenses

Income

	A	B	C
	Source	Gross	Net
67	Your wages or salary	___________________	___________________
68	Your spouse’s
	wages or salary	___________________	___________________
69	Interest or dividends	___________________	___________________
70	Business income	___________________	___________________
71	Rental income	___________________	___________________
72	Your pension	___________________	___________________
73	Your spouse’s pension	___________________	___________________
74	Child support	___________________	___________________
75	Alimony	___________________	___________________

76Other (specify)

________________ ___________________ ___________________

________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
________________	___________________	___________________
77 Add Lines 67 through 76, Column C.
This amount is your total net income.		____________________

Necessary monthly living expenses

A	B
Expense	Amount

78Rent (not included

	in Part G, Line 59)			___________________
79	Groceries
	(number of people____)			___________________
80	Installment pmts. from
	Part G, Line 66, Col. E			___________________
81	Utilities	a	gas	___________________
		b	water	___________________
		c	electric	___________________
		d	telephone	___________________
82	Transportation			___________________
83	Insurance	a	life	___________________
	(monthly	b	health	___________________
	premiums) c		home	___________________
		d	car	___________________

84Medical (not covered

	in Line 83b above)	___________________
85	Estimated tax payments	___________________
86	Court-ordered payments	___________________

87Other (specify)

__________________ ___________________

88Add Lines 78 through 87. This amount is your

total expenses.

___________________

89 Subtract Line 88 from Line 77. This amount is your net income after expenses.

89 ___________________

Part I: Complete any additional asset or income information

90Write any additional information you have about your assets or income that was not included in any of the preceding parts. Be sure to include a statement regarding the prospect of any increase in the value of your assets or your present income.

_____________________________________________________________________________________________________________

Section 3: Sign below

Under penalties of perjury, I state that I have examined this statement of assets, liabilities, and other information and, to the best of my knowledge, it is true, correct, and complete.

______________________________________________/___/_____ ______________________________________________/___/_____

Petitioner’s signature (not representative)

Date

Spouse’s signature

Date

Page 4 of 4

This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is REQUIRED. Failure to provide information
could result in this form not being processed. This form has been approved by the Forms Management Center.	IL-492-3683	BOA-4 (R-4/01)

Dos and Don'ts

When filling out the Illinois BOA-4 form, there are important guidelines to follow to ensure accuracy and compliance. Below are four key dos and don'ts:

Do provide accurate personal information, including your name, address, and Social Security number.
Do ensure that all financial information, such as income and expenses, is up to date and reflects your current situation.
Don't leave any sections blank; if a section does not apply to you, indicate that with "N/A" or a similar notation.
Don't forget to sign and date the form before submission, as this is a crucial step in validating your application.

Illinois Boa 4: Usage Instruction

Filling out the Illinois BOA-4 form is a crucial step in providing your financial information. This form requires you to detail your personal and financial situation, including income, assets, and liabilities. After completing the form, you will submit it to the appropriate authorities for processing.

Personal Information: In Section 1, Part A, indicate your marital status (single, married, or separated). Fill in your name, address, phone number, and Social Security number. If unemployed, specify how long you have been without work.
Employment Details: Provide information about your current or former employer, including the name, address, and your occupation. Include your date of birth and next of kin's details.
Spouse’s Information: If married, complete Part B with your spouse’s information, including their name, address, phone number, Social Security number, employment details, and income.
Financial Information: In Section 2, Part A, list your bank accounts, including the type of account, institution name, address, account number, and balance. Repeat this for credit cards in Part B.
Real Property: In Part C, describe any real property you own, including how it is titled and its physical address.
Insurance Policies: In Part D, provide details about your life and health insurance policies, including policy numbers and face amounts.
Securities: In Part E, list any securities you own, including their type, location, and present value.
Liabilities: In Part F, answer questions regarding any pending bankruptcy or foreclosure proceedings. Fill in your liabilities in Part G, including cash, bank accounts, vehicles, and taxes owed.
Income and Expenses: In Part H, detail your monthly income sources and expenses. Calculate your total income and expenses, then determine your net income after expenses.
Additional Information: In Part I, write any additional information about your assets or income that was not covered in previous sections.
Signature: Finally, sign the form under penalties of perjury, confirming that the information provided is true and complete. Include the date of your signature.