Official Illinois Wage Verification Form in PDF Open Editor

Official Illinois Wage Verification Form in PDF

The Illinois Wage Verification form is a document that allows employees to authorize their employers to share specific wage information with the Illinois Department of Human Services. This form is essential for individuals seeking assistance with childcare payments, as it ensures that the reported wages are accurate and verified. Completing this form accurately helps prevent any potential issues with childcare case approvals or payments.

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The Illinois Wage Verification form plays a crucial role in the process of verifying employment and income for individuals seeking childcare assistance. This document is specifically designed for employees to authorize their employers to disclose essential wage information to the Illinois Department of Human Services. It encompasses various components, including the employee's name, job title, and pay details such as hourly rate, commissions, and tips. Employers are required to fill out specific sections, which include the employee's work schedule and any leave details, ensuring that all information is accurate and up-to-date. The form also emphasizes the importance of honesty, as providing false information may lead to serious consequences, including the potential loss of childcare payments or denial of the childcare case. To maintain efficiency, the completed form must be submitted to Illinois Action for Children within ten business days, underscoring the time-sensitive nature of the verification process. This form serves as a vital link between employees and the support they need for childcare, ensuring that financial assistance is based on verified and truthful information.

Frequently Asked Questions

What is the Illinois Wage Verification form?

The Illinois Wage Verification form is a document used to verify an employee's wages and work schedule for the Illinois Department of Human Services. It is primarily used to assess eligibility for childcare assistance programs. The form must be completed by the employee's employer and returned within a specified timeframe.

Who needs to complete the Illinois Wage Verification form?

Employees applying for childcare assistance through the Illinois Department of Human Services must have this form completed by their employer. The employer provides essential information about the employee’s wages, job title, and work schedule.

What information is required from the employer?

The employer must provide the employee's name, start date, hourly pay rate, any commissions or tips, pay period frequency, job title, and work schedule. Additionally, the employer needs to indicate whether the employee is paid in cash and provide their contact information.

What happens if the form is not completed accurately?

If the form contains fraudulent, false, or misleading information, it can lead to serious consequences. This may include the loss of childcare payments or the cancellation or denial of the childcare case. Accuracy is crucial.

How long does the employer have to return the completed form?

The employer must return the completed Illinois Wage Verification form within 10 business days. Timeliness is essential to ensure that the employee's application for childcare assistance is processed without delays.

What should I do if my work schedule varies?

If your work schedule varies, you should provide an example of your typical hours on the form. Clearly outline your schedule for each day of the week, indicating when you start and finish work. This helps the Department of Human Services understand your availability.

Can I authorize my employer to release my wage information?

Yes, by signing the Illinois Wage Verification form, you authorize your employer to release your wage information to the Illinois Department of Human Services. This consent is necessary for the verification process.

Where should the completed form be sent?

The completed Illinois Wage Verification form must be returned to Illinois Action For Children at 1340 South Darren Avenue, 3rd Floor, Chicago, IL 60608. Make sure it is sent to the correct address to avoid processing delays.

Form Specifications

Fact Name Details
Governing Law The Illinois Wage Verification form is governed by the Illinois Child Care Assistance Program (CCAP) regulations.
Purpose This form is used to verify an employee's wages for the purpose of determining eligibility for child care assistance.
Authorization Clients must authorize their employer to release wage information to the Illinois Department of Human Services.
Fraud Warning Providing false or misleading information can lead to loss of child care payments and potential denial of the case.
Employer's Responsibility The employer is responsible for completing the job information section of the form.
Submission Deadline The completed form must be returned to Illinois Action for Children within 10 business days.
Payment Types Employers must indicate whether the employee is paid in cash or through other means.
Work Schedule The form requires a detailed work schedule, including hours worked each day of the week.
Employer Information Employers must provide their name, address, and contact information on the form.

Common mistakes

  1. Not signing the form. The client must provide their signature to authorize the release of information. Without this, the form is incomplete.

  2. Failing to provide the correct client case number. This number is essential for identifying the specific case and ensuring the information is processed accurately.

  3. Leaving job information blank. All fields related to the employee's job, such as job title and pay rate, must be filled out by the employer.

  4. Not indicating the correct pay period. It is important to select the right option (weekly, bi-weekly, etc.) to reflect how the employee is compensated.

  5. Providing inconsistent work schedule information. If the schedule varies, a clear example should be included. This helps avoid confusion.

  6. Ignoring the submission deadline. The form must be returned within 10 business days. Delays can affect childcare payments.

Form Preview

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

 

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

 

 

 

 

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's important to follow certain guidelines to ensure accuracy and compliance. Here’s a helpful list of things you should and shouldn’t do:

  • Do read the form carefully before starting to fill it out.
  • Do provide accurate and truthful information about your employment.
  • Do have your employer complete the job information section to avoid delays.
  • Do sign and date the form to confirm your authorization.
  • Don't leave any required fields blank; incomplete forms can be rejected.
  • Don't provide false information; this can lead to serious consequences.

By following these guidelines, you can help ensure that your wage verification process goes smoothly.

Documents used along the form

The Illinois Wage Verification form is an essential document for individuals seeking assistance with childcare payments. It serves to confirm employment details and income information directly from the employer. However, several other forms and documents often accompany this form to ensure a smooth process. Understanding these related documents can help streamline your application for childcare assistance.

  • Child Care Application Form: This form collects personal information, household details, and the specific type of childcare assistance being requested. It is the starting point for many seeking support.
  • Income Verification Form: This document provides a comprehensive overview of an applicant's income sources, including wages, benefits, and any additional earnings. It helps determine eligibility for assistance.
  • Employment Verification Letter: A letter from the employer confirming the employee's job title, length of employment, and salary. It serves as a supplementary proof of income.
  • Child Care Provider Agreement: This agreement outlines the terms and conditions between the parent and the childcare provider. It details payment arrangements, services provided, and responsibilities of both parties.
  • Tax Return Documents: Applicants may need to submit copies of their most recent tax returns to provide a complete picture of their financial situation.
  • Proof of Residency: Documents such as utility bills or lease agreements that verify the applicant's current address. This is often required to confirm eligibility based on location.
  • Social Security Number Verification: A document that verifies the applicant's Social Security number, which is essential for processing assistance applications.
  • Dirt Bike Bill of Sale: When engaging in transactions for off-road vehicles, it's important to utilize the official Dirt Bike Bill of Sale documentation to ensure all legal requirements are met and ownership is properly transferred.
  • Child’s Birth Certificate: A copy of the child’s birth certificate may be required to confirm the child’s age and eligibility for childcare services.
  • Release of Information Form: This form allows the sharing of personal information between agencies involved in the childcare assistance process, ensuring a coordinated approach to support.

Each of these documents plays a vital role in the application process for childcare assistance in Illinois. Familiarizing yourself with them can help ensure that you provide all necessary information and avoid delays in receiving support. By understanding the requirements, you can navigate the process with greater ease and confidence.

Misconceptions

Understanding the Illinois Wage Verification form is crucial for ensuring smooth processing of childcare payments. However, several misconceptions can lead to confusion. Here are five common misunderstandings about this form:

  1. It’s only for full-time employees. Many believe that the Illinois Wage Verification form is applicable only to full-time workers. In reality, this form can be used for part-time employees as well. Any worker receiving compensation for their services, regardless of hours worked, may need to have their wages verified.
  2. Employers can refuse to complete the form. Some think that employers have the right to decline filling out the form. However, if an employee requests it for childcare assistance, employers are obligated to provide accurate wage information. This is a necessary step in the process.
  3. Information on the form is confidential. While it’s understandable to be concerned about privacy, the information provided on the form is shared with the Illinois Department of Human Services for the purpose of verifying eligibility for childcare assistance. The data is used solely for this purpose and is handled with care.
  4. Only hourly wages need to be reported. A common misconception is that only hourly wages are relevant. The form also requires information about commissions and tips, which are important components of an employee's total income. All sources of income contribute to the verification process.
  5. The form can be submitted anytime. Some individuals may think they can submit the form at their convenience. However, it must be returned to the specified address within 10 business days to avoid delays in childcare payment processing. Timeliness is key in this process.

Being aware of these misconceptions can help streamline the wage verification process and ensure that childcare assistance is received without unnecessary complications.