Form IL444-2790 at a glance
What it is: The Self-Employment Record is a State of Illinois Department of Human Services form.
Where and when to file: The Department will need a copy of the record you choose to use.
Because you are self-employed, you are required to report all of your employment income and employment expenses to the Department of Human Services.
A filled-in Form IL444-2790 example: a baker records one month
How to fill out Form IL444-2790, box by box
Client Name, Case Number, Address, Individual ID, Date and the period
Enter your Client Name, Case Number, Address and Individual ID.
Enter the Date.
Enter the period this self-employment income is for, after "period of" and after "through".
Business Income
Under Business Income, enter the Source, the Date Received and the Gross Income.
To do this you must write down all money you take in and its source.
Be sure to include all transactions which occurred during your reporting period.
Business Expenses
Under Business Expenses, enter the Expense/Item Purchased, Paid to Whom and the Amount.
You must also write down any expenses you had in producing your income.
Expenses of producing income include but are not limited to things like inventory, materials, services, transportation, employee salaries, and loan payments.
You may choose what month you want to claim an expense, but you cannot claim the expense more than once.
You may only claim the percentage of the vehicle costs equal to the percentage of mileage that the vehicle is used for business purposes.
Depreciation, charitable contributions, entertainment, and personal expenses are NOT allowable business expenses.
More rules for Form IL444-2790
In order to determine your eligibility for assistance, you must provide the Department of Human Services with accurate and complete records of money you take in and the work expenses you pay out.
Also, save your receipts.
If you wish, you may use this form to keep your records. You are not required to complete this form, but you are required to keep accurate records of your self-employment income and expenses.
If you do complete this form, your DHS office will be better able to determine your eligibility for benefits.
Sources
[1] Form IL444-2790 (R-10-17), Self-Employment Record, State of Illinois Department of Human Services (the Official source link on this page).
