Fillable Mixed Earners Unemployment Compensation (MEUC) Application Personal Information (Illinois)

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Mixed Earners Unemployment Compensation (MEUC) Application Personal Information (Illinois)

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The Mixed Earners Unemployment Compensation (MEUC) Application Personal Information (Illinois) form is 2 pages long and contains:

  • 1 signature
  • 22 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

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www.ides.illinois.gov
Mixed Earners Unemployment Compensation (MEUC) Application
(Upload your completed application, tax return, and any supporting documents through the IDES
document upload portal. For more information, please visit our webpage at ides.illinois.gov/MEUC.)
Personal Information
First Name: ______________________________ Last Name: _________________________________
Date of Birth: ____________________________ Claimant ID: ________________________________
Phone Number: ___________________________ E-mail Address: ______________________________
1. As of 12/27/2020 or later, have you received benets from the Pandemic Unemployment Assistance
(PUA) program? Yes No
2. Have you applied for and received benets from the Unemployment Insurance (UI) benets program?
Yes No
If yes, what date did you le your initial claim for benets? _______________
3. Please select the current benet program in which you are receiving benets. Refer to your UI
Finding letter to determine your benet program.
Unemployment Insurance (UI)
Pandemic Emergency Unemployment Compensation (PEUC)
Extended Benets (EB)
Trade Readjustment Allowance (TRA)
4. Did you earn at least $5,000 in net self-employment income during the tax year before you applied for
Unemployment Insurance benets? Yes No
If so, check the applicable year(s): 2019 2020
5. Did you le a new benet year claim in 2020? Yes No
Did you le an income tax return for tax year 2019? Yes No
If yes, what was the net income reported on your tax document to the IRS? ____________
If yes, please stop. You are not eligible for MEUC. This program does not apply to individuals receiving
Pandemic Unemployment Assistance (PUA).
If no, please continue.
*Note: Net income is the amount you earned after taxes and all other deductions.
www.ides.illinois.gov
First Name: ______________________________ Last Name: _________________________________
Claimant ID: _____________________________
6. Did you file a new benefit year claim in 2021? Yes No
Did you file an income tax return for tax year 2020? Yes No
If yes, what was the net income reported on your tax document to the IRS? ____________
7. Please list the business/type of self-employment you performed.
_____________________________________________________________________________
8. If you have a FEIN or Employer account number, please provide it here: _______________
9. Can you provide proof of self-employed earnings? Yes
No
* Note: Supporting documentation must be provided with this application. A determination will be
made based on your responses to the application questions and documents provided at the time
you submit this application.
I hereby le a claim for Mixed Earners Unemployment Compensation (MEUC) benets. I certify that the
information for my MEUC benet claim is true and correct to the best of my knowledge and belief. I am aware
that the law prescribes penalties of ne and imprisonment for making false statements to obtain benets. I
understand that the information submitted by me may be veried through computer matching programs and may
be used by other Federal, State, or Local Agencies, and that information submitted by me to these agencies will
be used by IDES in determining my eligibility and amount of MEUC benets. I also understand that, pursuant to
Section 1900 of the Unemployment Insurance Act, any information that I provide to IDES in connection with the
claim may be shared with my former employers or their representatives.
Signature: ___________________________________________
Date: _______________________________________________
Please attach your tax document and any other supporting documents.
(For example, 1040 and Schedule C, Schedule K-1 (Form 1065))
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Mixed Earners Unemployment Compensation (MEUC) Application Personal Information (Illinois)

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Completed 8 September 2021

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