1069 form-2026

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The document is a referral form for employees to authorize their employer to release income information to the NYC Administration for Children's Services. It includes sections for employee details, employment verification by the employer, and gross income reporting for financial eligibility determination related to publicly funded child care services.

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Click ‘Get Form’ to open the 1069 form in the editor.
Begin by entering your name in the designated field for the employee’s name. This is crucial for identifying your information.
Next, provide your employer's name and address. Ensure accuracy as this information will be used for verification.
Fill in your home address, including apartment number, city, state, and zip code. This helps maintain clear communication.
Sign and date the authorization section to give consent for your income information to be released.
Your supervisor or payroll department will need to complete their section. They should enter employment details such as start and end dates, type of work, and regular schedule.
In the gross income section, indicate how often you are paid (weekly, bi-weekly, etc.) and fill in your gross hourly income if applicable.
Complete the gross payroll information for the past three months by listing hours worked and earnings accurately.

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