Illinois Income Verification PDF Details

In the heart of Illinois, particularly in bustling Chicago, the Illinois Income Verification form emerges as a crucial document for countless residents. Located at 1340 S Damen Avenue, this document is an essential tool for individuals applying for or receiving benefits through Illinois Action for Children, a program dedicated to supporting the welfare of children and families. The process starts with the applicant, who needs to provide their name and case number, and proceeds with an authorization for their employer to release pertinent income information. This step is foundational for establishing initial eligibility, with the understanding that further evidence of income will be required at subsequent evaluations. Employers play a significant role in this verification process, detailing the nature of the business, the employment specifics, and the compensation details of the employee. From the type of payment (be it cash, check, or otherwise) to the frequency and amount, every detail contributes to a comprehensive picture of the applicant's financial situation. Additionally, the form requests an outline of the employee's typical work schedule, offering a glimpse into their weekly commitments. This thorough approach underscores the importance of accuracy and honesty, as affirmed by the required signatures, thereby facilitating a smoother, more transparent eligibility assessment process for assistance programs aimed at enhancing the lives of children and families across Illinois.

QuestionAnswer
Form NameIllinois Income Verification
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescdvg verification income in waukegan il, il income verification, illinois act for children forms income verification, action for children verification form

Form Preview Example

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.

 

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

 

a.m.

 

 

 

 

p.m.

 

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

 

p.m.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To:

 

a.m.

 

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

a.m.

 

 

a.m.

 

 

 

 

p.m.

 

 

p.m.

 

p.m.

 

p.m.

 

p.m.

 

p.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-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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portion of gaps in self employment income verification form illinois

Write the information in Actualor averagenumber of hours, The employee is paid by check one, The employee is paid check one cid, The employee receives a gross, per pay period If amount varies, The employees gross hourly wage, per hour, The employee receives weekly tips, per week, Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday.

step 2 to filling out self employment income verification form illinois

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