Get Illinois Wage Verification Form

The Illinois Wage Verification form is a document used to authorize an employer to release specific wage information to the Illinois Department of Human Services. This form is essential for individuals receiving childcare assistance, as it helps verify income and employment details. Accurate completion of this form is crucial, as any misleading information may lead to the denial or cancellation of childcare benefits.

To ensure your childcare payments continue without interruption, please fill out the form by clicking the button below.

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The Illinois Wage Verification form is an essential document designed to facilitate the verification of employment details for individuals receiving childcare assistance. This form requires the employer to provide specific information about the employee, including their job title, hourly pay rate, and work schedule. Additionally, it captures any commissions or tips the employee may earn, ensuring a comprehensive overview of their income. The form emphasizes the importance of accuracy, as any fraudulent or misleading information can lead to serious consequences, such as the cancellation or denial of childcare payments. Employers are responsible for completing the form and returning it within ten business days to the designated address. By streamlining the verification process, this form helps ensure that families receive the support they need while maintaining accountability in the childcare assistance program.

Document Breakdown

Fact Name	Description
Purpose	The Illinois Wage Verification form is used to authorize employers to release employee wage information to the Illinois Department of Human Services.
Governing Law	This form is governed by the Illinois Child Care Assistance Program (CCAP) regulations.
Signature Requirement	Clients must sign the form to authorize the release of their wage information.
Employer's Role	Only employers can complete the job information section of the form, which includes details like pay rate and job title.
Verification Process	The information provided may be verified by phone, ensuring accuracy and preventing fraud.
Consequences of Fraud	Providing false information can lead to the loss of childcare payments and potential cancellation of the childcare case.
Submission Timeline	The completed form must be returned to Illinois Action for Children within 10 business days.
Work Schedule Details	Employers must provide a detailed work schedule, including hours worked each day of the week.

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Misconceptions

Understanding the Illinois Wage Verification form is crucial for those navigating childcare assistance. However, several misconceptions can lead to confusion. Here’s a list of common misunderstandings:

The form is optional. Many believe that completing the form is optional, but it is a requirement for verifying income when applying for childcare assistance.
Only employers can fill out the form. While the employer must provide specific information, the employee must also authorize the release of their wage information.
All employers know how to complete the form. Not all employers are familiar with the form or its requirements, which can lead to incomplete or incorrect submissions.
Submitting the form guarantees childcare payments. Completing the form does not guarantee assistance; it only provides necessary information for the review process.
Wage verification is only for full-time employees. Part-time employees also need to complete the form to verify their income, regardless of hours worked.
Fraudulent information is rarely checked. The Illinois Department of Human Services actively verifies the information provided, and inaccuracies can lead to serious consequences.
Commission and tips do not need to be reported. Any additional income, including commissions and tips, must be disclosed on the form to ensure accurate verification.
The form can be submitted at any time. There is a specific deadline for submission, typically within 10 business days, which must be adhered to.
Cash payments do not need to be reported. Whether an employee is paid in cash or by check, all forms of compensation must be reported on the form.
Once submitted, the form cannot be changed. If there are errors, it is possible to submit a corrected form, but it is best to ensure accuracy before submission.

By clearing up these misconceptions, individuals can better navigate the process of obtaining childcare assistance in Illinois.

Example - 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

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

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)

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Dos and Don'ts

When filling out the Illinois Wage Verification form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are six important dos and don'ts:

Do double-check all information for accuracy before submission.
Do ensure your employer completes the job information section thoroughly.
Do provide clear and honest details regarding your work schedule.
Do sign and date the form to validate your authorization.
Don't omit any required fields; incomplete forms can lead to delays.
Don't provide false information, as this may jeopardize your childcare payments.

Illinois Wage Verification: Usage Instruction

After gathering the necessary information, you can begin filling out the Illinois Wage Verification form. This form must be completed by your employer, so it’s important to ensure that all required details are accurately provided. Once filled out, the form needs to be returned to the specified address within 10 business days.

Client Authorization: At the top of the form, sign to authorize your employer to release your wage information to the Illinois Department of Human Services.
Client Case Information: Fill in your client case number and the date of completion.
Employee Information: Your employer should fill in your name, start date, and rate of hourly pay. If applicable, include commission and average tips.
Pay Period: Indicate how often you are paid (weekly, bi-weekly, twice a month, or monthly).
Cash Payment: Your employer needs to check “Yes” or “No” to indicate if you are paid in cash.
Job Title: Your employer should specify your job title.
Leave Information: If you are on leave, your employer should provide your return date and type of leave.
Work Schedule: Your employer should detail your work schedule. If it varies, provide an example for each day of the week, including start and end times.
Employer Information: Fill in the employer/company name, address, city, and phone number.
Employer Signature: Your employer must print their name, title, sign, and date the form.

Once the form is completed, make sure it is returned to Illinois Action For Children at the address provided. Timely submission is essential to avoid any interruptions in your childcare payments.