Get Illinois Income Verification Form

The Illinois Income Verification form is a crucial document used to confirm an employee's income for eligibility purposes in various assistance programs. This form requires signatures from both the employee and their employer, ensuring that the information provided is accurate and reliable. Completing this form is an essential step in the application process, so be sure to fill it out by clicking the button below.

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The Illinois Income Verification form plays a crucial role in determining eligibility for various assistance programs. It is designed to gather essential information about an employee's income directly from their employer. The form must be filled out by both the client and the employer, ensuring that the data provided is accurate and reliable. Clients are required to authorize their employers to disclose specific income details to Illinois Action for Children. This process not only helps establish initial eligibility but also sets the stage for future income verification during redetermination. Employers must provide comprehensive information, including the type of business, the employee's pay schedule, and their gross earnings. Additional details about the employee's work hours and any tips or commissions received are also necessary. By collecting this information, the form facilitates a transparent and efficient verification process, ultimately supporting families in need.

Document Breakdown

Fact Name	Details
Purpose	The Illinois Income Verification form is used to verify an employee's income for eligibility in various assistance programs, including those administered by Illinois Action for Children.
Employer Signature Required	This form must be signed by the employer to confirm the accuracy of the income information provided by the employee.
Eligibility Verification	It is specifically intended for initial eligibility assessments, with the understanding that additional income proof will be required during future redetermination processes.
Contact Information	The form includes contact details for Illinois Action for Children, located at 1340 S Damen Avenue, Chicago, IL 60608, including phone and fax numbers.
Governing Law	The use of this form is governed by Illinois state laws related to public assistance programs, ensuring compliance with state regulations for income verification.

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Misconceptions

Understanding the Illinois Income Verification form can be challenging. Here are some common misconceptions that people have about it:

It’s not necessary to have my employer sign the form. In fact, the form must be signed by your employer before submission. This signature verifies the information provided.
Once I submit the form, I don’t need to provide any more information. This is incorrect. The form is for initial eligibility, and you will need to submit additional proof of income during your next Redetermination.
Only full-time employees need to fill out this form. This is a misconception. Part-time employees also need to complete the form to verify their income.
The form is only for salaried employees. Not true. It applies to all types of compensation, including hourly wages and commissions.
I can submit the form without my employer’s information. This is incorrect. Employer details are crucial for verifying your income.
My employer can refuse to fill out the form. While employers may have concerns, they are generally required to provide this information for employees seeking assistance.
The information on the form is confidential and won’t be shared. While the form is treated with confidentiality, it may be verified by Action for Children or other agencies.
It’s okay to estimate my income on the form. Estimates are not ideal. You should provide accurate figures to avoid complications later.
The form is only for specific types of assistance programs. This form is widely used across various programs that require income verification.
I can submit the form via email or online. Typically, this form must be submitted physically, as it requires signatures from both the employee and employer.

Example - 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.

p.m.

To:

a.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-

Dos and Don'ts

When filling out the Illinois Income Verification form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of things to do and avoid during this process.

Do provide accurate and complete information.
Do ensure that your employer signs the form before submission.
Do keep a copy of the completed form for your records.
Do submit any additional proof of income as requested during the Redetermination process.
Do double-check the contact information for your employer.

Don't leave any sections of the form blank.
Don't forget to include your case number and personal details.
Don't provide false information, as this can lead to penalties.
Don't submit the form without the required signatures.
Don't ignore the instructions for your employer's section of the form.

Illinois Income Verification: Usage Instruction

Completing the Illinois Income Verification form is an important step in the eligibility process. Once you fill out the necessary information, your employer will need to sign it before submission. Follow the steps below to ensure you provide all required details accurately.

Begin by entering your Client’s Name at the top of the form.
Next, fill in your Case Number.
Provide your Employee’s Name on the designated line.
Sign the authorization section, allowing your employer to release information to Illinois Action for Children.
Include the date of your signature.
Leave the section for your employer to complete, which includes business details.
Your employer should fill in the Name of Business and the Type of Business or Work Performed.
They will also need to provide their Name, Business Address, and Business Phone.
Your employer must indicate the Start Date of Current Employment.
They should specify the Actual or Average Number of Hours Worked per week.
Your employer will check how the employee is paid: Cash, Personal Check, Payroll Check, or Other.
They will also indicate the pay frequency: Weekly, Biweekly, Semi-monthly, or Monthly.
Your employer needs to enter the gross amount earned per pay period, along with the gross hourly wage.
If applicable, they should provide an estimate of weekly tips or commissions.
Your employer will detail your typical work schedule by indicating the start and end times for each day of the week.
Finally, your employer must sign and date the form, providing their SSN/FEIN and phone number.

Once the form is complete and signed by your employer, submit it to the designated office. Be prepared to provide additional proof of income during your next Redetermination. This process helps ensure that all information is verified and accurate.