Applying and getting approved

Self employed requirements


English PDF: H1049.pdf
Spanish PDF: H1049-S.pdf
PDF: H1049-3.pdf


Updated: 7/2004


To supply

  • a way where litigant may report self-employment earnings and expenditures if accurate income tax or business documents are not offered; and
  • a means for processing a client's web month-to-month earnings from self-employment.
  • a means for determining earnings for qualifying households with a farm loss.

When you should Prepare

The worker provides page 1-2 of Form H1049 to every client with self-employment earnings. The client finishes all things on the type. It should be signed and dated by the applicant, spouse, or authorized agent.

The worker may help out with finishing the proper execution. If so, the employee either initials each entry made (the client must initial the entry in addition) or signs as having helped prepare the proper execution.

Workers must return receipts, invoices, or other verifying reports provided by the customer at the earliest opportunity.

Wide range of Copies


The worker can provide an availability of Form H1049 for customers to use in recording income and costs for future certifications.


File Form H1049 in the event folder with the matching Form H1010-B.

Form Retention

Hold Form H1049 for 36 months. If other papers tend to be posted in the place of, or perhaps in addition, to create H1049, also hold copies of these documents for three years.


Guidelines the client-completed portion of the shape are on Page 2 of type.

The employee must document verification or computations on Page 3 of Form H1049 or regarding the Food Stamp or TANF Worksheet.

Part I — determine annual or regular self-employment earnings. Document the projection duration in area IV.

Part II — determine all the other self-employment frequencies except yearly or seasonal.

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