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Medicaid self employed income Form: What You Should Know

The Form DHS must be signed and dated (or certified) by a duly identified representative or authorized officer of any health agency. The information gathered on your self-employment income form will be used by the Division to determine if your self-employment income qualifies for a specific benefit, but not all information is needed to make this determination. For example, information will not be gathered about: 1. How much of your business income is derived from the sale of goods and services for resale  The report will contain the sale of a good or service for resale that a taxpayer claimed as a business expense, including items for which the taxpayer did not sell directly to customers. For example, the item on your self-employment income list would be “Sale of gasoline for resale.”  2. Total of self-employment wages and salaries, net taxable income, and net investment income, net of expenses. The total of  these three items is not limited to the amount of your gross receipts from sales during the preceding tax fiscal year. It includes: Wages (self-employment earnings from job), net taxable income, and net investment income, net of expenses, from all of your business activities. This does not include income from self-employment activity conducted separately from your regular job activities. In general, the net of expenses is the amount of your gross receipts less the amount of your expenses. Net self-employment income for a calendar tax year is the amount of your self-employment profit that is expected to be realized over a fiscal year, which can also be called your self-employment profit. If you are a “qualified individual,” see Qualified Individual — Qualifying for Self-Employment Income.  For more information, consult our Self-Employment Income Fact Sheet. Note: You should not include income in the above categories that is derived from the sale of inventory in the ordinary course of business or that is not used in a trade or business (including rental income or royalty income).  (2) Income arising without the active conduct of a business.

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