Form Il 444 3514 PDF Details

Navigating childcare support can often seem like a daunting task for parents and guardians, especially when it comes to verifying income to qualify for assistance. The State of Illinois Department of Human Services - Bureau of Child Care and Development has streamlined this process with the creation of the IL 444 3514 form, a crucial document designed for wage verification purposes. This form acts as a bridge between employers and the Illinois Department of Human Services, enabling a smoother transaction of information regarding an employee's earnings, job title, and work schedule. It requires detailed inputs from both the employee seeking child care assistance and their employer, covering aspects such as rate of hourly pay, commission, tips, and the nature of the payment whether it’s in cash or otherwise. Furthermore, it features sections devoted to work schedules, offering a snapshot of the applicant’s working hours, which can vary on a daily or weekly basis. The significance of this document cannot be overstated, as any fraudulent, false, or misleading information provided might not only jeopardize the childcare payments but also lead to cancellation or denial of the childcare case. Through this form, the Illinois Department of Human Services ensures that only eligible candidates receive the support they need, maintaining the integrity and efficacy of their childcare programs.

QuestionAnswer
Form NameForm Il 444 3514
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschild care verification form, misleading, IL444-3514, TUES

Form Preview Example

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 Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

PM

 

 

 

PM

 

PM

PM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

AM

 

 

AM

AM

 

 

AM

 

AM

AM

AM

 

 

 

PM

 

 

PM

PM

 

 

 

PM

 

PM

PM

PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do these hours vary?

 

 

 

 

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer / Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address:

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

Employer Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name Printed

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

Employer Signature

THIS FORM MUST BE COMPLETED BY YOUR

EMPLOYER AND RETURNED TO THE ADDRESS

AT THE RIGHT WITHIN 10 BUSINESS DAYS.

Date

PLEASE RETURN FORM TO:

IL444-3514 (N-1-11)

Page # of ##

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1. It is critical to fill out the varies properly, hence pay close attention while filling in the segments comprising these specific blanks:

Stage # 1 in filling out misleading

2. Once your current task is complete, take the next step – fill out all of these fields - If on leave Return Date, Yes, Type of Leave, WORK SCHEDULE If your schedule, MON, TUES, WED, THURS, FRI, SAT, SUN, FROM, AM PM, AM PM, and AM PM with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

misleading writing process outlined (part 2)

3. In this specific stage, have a look at Employer Name Printed, Employer Signature, THIS FORM MUST BE COMPLETED BY YOUR, EMPLOYER AND RETURNED TO THE, AT THE RIGHT WITHIN BUSINESS DAYS, Title, Date, PLEASE RETURN FORM TO, IL N, and Page of. All of these have to be filled out with utmost focus on detail.

Stage # 3 in filling out misleading

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