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Step 12 - Health Insurance Checkbox and Signature

Line 41

If you check this box, you are authorizing IDOR to provide you with health insurance eligibility information and to share your contact and income information with the State health benefits exchange.

Note: If you checked this box on your prior year Form IL-1040, you do not need to check it again. The same information as what was provided previously will be sent again.

Per P.A. 102-0799, IDOR will share your contact and income information with the Department of Healthcare and Family Services (DHFS) and the Department of Insurance (DoI) in order to provide information to you about your eligibility for health insurance benefits. The information provided to you will also include health insurance enrollment options.

The information shared with the other state agencies shall be kept confidential and used only in determining your eligibility for these benefits.

Sign and date

You, and your spouse if filing jointly, must sign and date your return. If you are filing for a minor as a parent or guardian, you must sign and date the return.

If you do not sign your return,

  • it will be considered not filed and you may be subject to a nonfiler penalty.
  • and three years have passed since the extended due date of that return, any overpayment will be forfeited.

Attach: Staple all required copies of forms and schedules, powers of attorney, and letters of estate or office to the tax return.

Paid preparer

If you pay someone to prepare your return, the paid preparer must also sign and date your return, provide a phone number, and enter their Preparer Tax Identification Number (PTIN) issued by the IRS. Check the box if the paid preparer is self-employed. If the paid preparer is employed with a professional tax preparation firm, the paid preparer also must provide the name, the Federal Employer Identification Number (FEIN), the address, and phone number of the firm.

Third party designee (optional)

If you want to allow another person to discuss this return and any previous return that affects the liability reported on this return with us, check the box and print the designee’s name and telephone number. The authorization will allow your designee to answer any questions that arise during the processing of your return, call us with questions about your return, and receive or respond to notices we send. You may revoke the authorization at any time by calling or writing us.