Self- Employment Verification Form printable pdf download

Self- Employment Verification Form

EARLY CHILDHOOD SCHOOL READINESS PROGRAMS

VERIFICATION OF SELF EMPLOYMENT

Policy Clarification

Regarding Self Employment and Cash Paid Employment

It is the parent/guardian’s responsibility to inform the School Readiness (SR) Programs of the self-employment of any

parent/guardian in the family. The parent/guardian must submit verification of self-employment, including all supporting

verification of self-employment income, as required at the time of initial application and at each subsequent

redetermination.

Self Employment Requirements:

If you are paid in cash or check and your employer does not take out your taxes or if you are operating your

own business, then you are considered to be self-employed. Due to clarification you now need to submit the

following verification at each redetermination:

□ Copy of most current/recent Federal Income Tax Return

□ Copy of current and active business license

(Request for Transcript of Tax Return can be mailed to you upon request so you can receive an official copy of your most

recent Income Tax Return from the IRS)

If you are newly Self-Employed within current tax year and do not yet have an income tax return then:

□ Parent/Guardian Self-Employment Income Worksheet AND Self-Employment Statement

Along with a copy of current and active business license; documentation to support the statement such as:

□ Accounting ledgers

□ Account statements

□ Bank deposit slips

□ Canceled checks

□ Receipts

□ Credit card charge slips

□ Invoices

□ Credit card sales slips

Business Expenses: Generally, you may claim any business expense that is allowed by the Internal Revenue

Service (IRS), with the exception a deduction for depreciation.

Example of business expenses are:

 Materials/chemicals/supplies use to produce goods or services

 Space rent and business utilities

 Maintenance of business property

 Payroll or wages

 Business phone

 Vehicle expense for business purpose with documentation

 Legal, accounting or other professional fees

*Certain statuses may require additional documentation.

Verification of Self Employment- rev. 5/10/2016

Self- Employment Verification Form