TX HHS Form 3085. Statement of Self-Employment Income

The TX HHS Form 3085, Statement of Self-Employment Income, is a crucial document for individuals who earn income through self-employment. This form helps solve the problem of accurately reporting self-employment income to the County Indigent Health Care Program (CIHCP). Typically, this form is used by self-employed individuals who need to provide proof of their income to the CIHCP.

The form requires specific information from the individual, including their name, the number of months covered by the income statement, and a description of how they earned their income. Additionally, the form asks for a list of business expenses and income, with the instruction to attach receipts or other verifying papers. This ensures that the provided information is accurate and complete.

It's essential to note that providing false information on this form can result in disqualification from the CIHCP due to fraud. The form also includes a section for the individual to sign and date, confirming that the information provided is true, correct, and complete. By filling out this form accurately and completely, self-employed individuals can ensure they are eligible for the CIHCP program.

• This form is used by self-employed individuals who need to provide proof of their income to the County Indigent Health Care Program (CIHCP).
• The form requires specific information about the individual's name, income, and expenses.
• Accurate and complete information is essential to avoid disqualification from the CIHCP program due to fraud.