Line-by-line instructions for Schedule C
Complete Schedule C if you or your spouse are
11a Mark “yes” if anyone provides or helps you or
eligible for Medicare and want help paying for
your spouse pay for food, mortgage, rent, heat/
prescription drugs or the $25 monthly rebate
gas, electricity, water or property taxes.
available through Illinois Cares Rx.
Otherwise, mark “no” and go to Line 12.
If you mark “no” on Line 36, 36a or 36b of Form IL-
Do not count: food stamps, house repairs,
1363 you must complete Schedule C. If you mark
help from a housing agency (Section 8), an
“yes” on Line 36, 36a or 36b , you do not need to
energy assistance program, Meal on Wheels,
complete Schedule C.
or help with medical treatments and drugs.
It is important that you complete your “Extra
11b If “yes,” list how much help you get each
Help” application and send it to Social Security for a
month. If the amount changes from month to
decision even if you do not think you will be eligible.
month or you do not receive it every month, tell
us the average monthly amount for the past
year.
12 List the savings and resources owned by you
Step 1: Tell us about yourself (claimant)
or your spouse.
and your spouse.
12a List the total amount of bank accounts
1 through 4
(checking, savings and certificates of deposit).
Complete the requested identification
12b List the total amount of stocks, bonds, savings
information for you and your spouse.
bonds, mutual funds, individual retirement
Complete Lines 3a, 3b, and 4 only if you
accounts and similar investments.
checked Marital status 2, “Married and living
together,” on Line 2e. Otherwise, if you do
12c List the total amount of any other cash you or
not have a spouse, if your spouse is
your spouse have at home or elsewhere.
deceased, or if you are not living in the same
For Lines 12a, 12b, and 12c, if you and your
household with your spouse, go to Step 2.
spouse do not own an item listed, place a
zero in the space.
Step 2: Complete the following
13a Mark “yes” if you own life insurance policies
information about you and
with a total face value greater than $1,500.
your spouse (if married and
(You may need to call your insurance company
living together)
to help answer this question). Otherwise, mark
“no,” and go to Line 14.
5
Mark “yes” if you worked in 2009 or 2010.
13b List the amount you would get by cashing in
Otherwise, mark “no.”
your life insurance policies. Cash value is
6
List the amount you expect to earn in wages,
different than the face value. (You may need to
before taxes, in 2010. If none, place a zero in
call your insurance company to help answer
the space.
this question).
7
List the amount of your expected earnings
14
Mark “yes” if you plan to use any of the savings
or losses from self-employment in 2010.
or resources on Lines 12a, 12b, 12c, and 13b
If none, place a zero in the space.
to pay for funeral and burial expenses for
8
Mark “yes” if the amounts listed on Lines 6 or 7
yourself or your spouse. Otherwise, mark “no.”
have decreased in the last two years.
Otherwise, mark “no.”
15
Mark “yes” if you or your spouse own real
9
List the month and year that you recently
estate other than your home and the property
stopped working (or you plan to stop working).
on which your home is located. Otherwise,
mark “no.”
10 List the number of relatives who live with you
and depend on you or your spouse for at least
one-half of their financial support. If none,
place a zero in the box.
(Continued on next page.)
Instructions for Schedule C / IL-1363 (R-12/09)