Kitchener-Waterloo - Social Services

SOCIAL SERVICESChildren’s ServicesP.O. Box 161299 Regina Street, SouthWaterloo, Ontario N2J 4G6Telephone: (519) 883-2200Fax: (519) 746-7382February 21, 2013To whom it may concern:You have contacted our office to request Child Care Subsidy for your Self-Employedactivity. In order for you to apply for Child Care Subsidy, you need to submit informationabout your self-employment to our office before an intake can be completed. Thisinformation helps our staff to:Determine if the activity you are involved in can be considered for accessingChild Care Subsidy;Better understand the nature of your business and its viability;Calculate the hours of child care you may be eligible to receive; andCalculate your income.Please find enclosed in this package the following documents:Documents Required for Self-Employed Businesses;Business Information Questionnaire;Business Income and Expense Statement.Please review the documents carefully to ensure you fully understand what needs to beprovided to our office so that we can confirm your income and hours as a self-employedperson. If you submit your package and it is not completed in full, we will be unable todetermine if you are eligible to apply and the package will be returned to you.If you have questions concerning the information in the package, please contactDenyse Loehndorf, Supervisor at (519) 575-4757 ext: 5504.Sincerely,Sheri PhillipsManager, Child Care Subsidy

SOCIAL SERVICESChildren’s ServicesP.O. Box 161299 Regina Street, SouthWaterloo, Ontario N2J 4G6Telephone: (519) 883-2200Fax: (519) 746-7382DOCUMENTS REQUIRED FOR SELF-EMPLOYED BUSINESSESYou need to send the right documents for your business. This chart will help you decide what documents to send.If This is the Kindof Business YouHave:1. Sole Proprietorship( not incorporated )This means you arethe only person thatowns this business2. Sole Proprietorship( not incorporated )This means youare the onlyperson that ownsthis businessYou are applyingfor Child CareSubsidy beforeJune 15 thIf this is YourBusiness StartDate:Current Calendar YearYour businessstarted between afterJanuary 1 st andbefore December31 st of the currentyear.For example: if today isNovember 2012 andyour business started inMarch 2012.Previous Calendar YearYour businessstarted after January1 st and beforeDecember 31 st of lastyearFor example: if today isNovember 2012 andyour business started inMarch of 2011.You Must Bring These Documents:The completed “Business Information Questionnaire,” andThe “Business Income/Expense Statements” from the businessstart date to the end of the most recent quarter, andThe “Statements of Activity” for your Business bank account.These statements must be from the business start date to the endof the most recent quarter.The completed “Business Information Questionnaire,” andThe “Business Income/Expense Statements” from the businessstart date to the end of the most recent quarter, andThe “Statements of Activity” for your Business bank account.These statements must be from the business start date to the endof the most recent quarter.

If This is the Kindof Business YouHave:3. Sole Proprietorship( not incorporated)This means you arethe only person thatowns this businessYou are applying forChild Care Subsidyafter June 15 th4. Sole Proprietorship( not incorporated)This means you arethe only person thatowns this businessYou are applying forChild Care Subsidyafter June 15 thIf this is YourBusiness StartDate:Previous Calendar Yearwhere the businessbegan after January ofthe previous year.For example, you areapplying for Child CareSubsidy in July 2012and your businessstarted March 2011In January of PreviousCalendar YearSubsidy applicationis after June 15 thYou Must Bring These Documents:The completed “Business Information Questionnaire,” andA copy of the most recent Income Tax Return and the “Statement ofBusiness/Professional Activities,” andThe “Business Income/Expense Statement” from January of thecurrent year (this year) to the end the of most recent quarter, andThe “Statements of Activity” for your Business bank account.These statements must be from the business start date to the endof the most recent quarter.The completed “Business Information Questionnaire,” andA copy of the most recent Income Tax Return and the “Statement ofBusiness/Professional Activities,” andYour Federal Notice of Assessment ( if you have received it)

If This is the Kindof Business YouHave:If this is YourBusiness StartDate:1. Corporation Current Calendar YearYour businessstarted between afterJanuary 1 st andbefore December31 st of the currentyear.For example: if today isNovember 2012 andyour business started inMarch 2012.2. CorporationYou are applying forChild Care Subsidyless than 18 monthsfrom your businessfiscal year end3. CorporationYou are applying forChild Care Subsidyand it is 18 monthsor more from yourbusiness fiscal yearendPrevious CalendarYear(s)For example: if today isNovember 2012 andyour business started in2011 or earlierPrevious CalendarYear(s)For example: if today isNovember 2012 andyour business started in2011 or earlierYou Must Bring These Documents:The completed “Business Information Questionnaire,” andThe “Business Income/Expense Statement” from the business startdate to the end the of most recent quarter, andThe “Statements of Activity” for your Business bank account.These statements must be from the business start date to the endof the most recent quarter.Article of IncorporationThe completed “Business Information Questionnaire,” andThe “Business Income/Expense Statement” from the business startdate to the end the of most recent quarter, andThe “Statements of Activity” for your Business bank account.These statements must be from the business start date to the endof the most recent quarterArticle of IncorporationThe completed “Business Information Questionnaire,” andYour most recent “Corporate Tax Return,” andYour most recent “Corporate Notice of Assessment” (if you havereceived it)Article of Incorporation

SOCIAL SERVICESChildren’s ServicesP.o. Box 161299 Regina Street, SouthWaterloo, Ontario N2J 4G6Telephone: (519) 883-2200Fax: (519) 746-7382Business Information QuestionnaireYou are applying for Child Care Subsidy as a self-employed person. Before we canconsider your application, our office needs to have an understanding of the nature ofyour business, your business activities and how you receive income from yourbusiness.Please answer all the questions below in the space provided and if more space isneeded, you can add additional pages. If the questionnaire is not completed or thequestions are not answered, we will be unable to review your application and it will bereturned to you.If you have any questions, please contact Denyse Loehndorf, Supervisor at (519)575-4757 ext: 5504.Please print clearlyQuestions about Business OperationContact Information:Your Name: __________________________ Spouse’s Name: _______________________Address: __________________________________________________________________E-mail:________________________________ Phone/Cell#: _________________________Name of the Business_______________________________________1. When did you start your business? (month & year)2. If your business has been in existence for a minimum of a year, please identify if therewere any breaks in business activity and include the time frame (For example, seasonalnature, illness, maternity leave):3. Is your business registered? Yes NoIf yes, please attach a copy of your business registration.

4. Is your business incorporated? Yes NoIf yes, please provide a copy of the Article of Incorporation and identify your business yearend date.5. Do you have any partners in your business? Yes NoIf yes, please list the names of the partners and their percentage (%) of the partnership:1) _____________________________________________ ____%2) _____________________________________________ ____%3) _____________________________________________ ____%4) _____________________________________________ ____%6. What is your type of business? What product or services are you selling?7. Where and to whom do you sell your product or services? (provide details)8. Describe how you market/sell your product or services. (For example, directsales/service, trade show, distributors, etc.)9. Do you primarily do business with/for one company/customer? Yes NoIf yes, please list the name of the company: ____________________________If no, how many different companies/customers do you do business with in a month?

10. Please list the days and hours your business operates:Day Hours Day HoursMondayTuesdayWednesdayThursdayFridaySaturdaySunday11. Where does your business operate?a) Provide the address of the main office:b) Where are the business activities conducted? (For example, customer’s office,customer’s home, stores, construction job site, etc.)12. What is your role in the business? Please list the days and hours that you work.Role:Day Hours Day HoursMondayTuesdayWednesdayThursdayFridaySaturdaySundayQuestions about Employees and Income13. Do you have employees in addition to yourself? Yes NoIf yes, please list how many employees and what their activities are. Please also attachcopies of the 2 most recent pay stubs to each of your employees.Employee NameActivity/Responsibility

14. Is your spouse (if applicable) involved in the business? Yes NoIf yes, please list his/her role, what his/her activities are and the days and hours thathe/she works in the business.Role:Day Hours Day HoursMondayTuesdayWednesdayThursdayFridaySaturdaySunday15. How do you pay yourself? (For example, draw, hourly wage, monthly salary)16. What other sources of income do you have to support your family’s financial needs inaddition to your business?17. Please identify:a) how much money you have invested in the business:b) The equipment needed to operate the business:c) The value of the Business Bank Accounts:d) The value of Business loans:

18. How do you claim your income for Income Tax Purposes? (For example, Employmentincome, commissions, self-employed income). It is important to be aware that theinformation you provide must be consistent with your income tax return.19. In detail, outline:Your business activities for a typical week;Include the amount of time you spend on these activities and the time of day.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I confirm that the information I have provided in this package is accurate and complete andfully describes all business activity I conduct._______________________________________Name (please print)_______________________________________Signature____________________Date

SOCIAL SERVICESChildren’s ServicesP.o. Box 161299 Regina Street, SouthWaterloo, Ontario N2J 4G6Telephone: (519) 883-2200Fax: (519) 746-7382BUSINESS INCOME/EXPENSE STATEMENTThis document must be completed in full. If the document has not beenfully completed, it will be returned to you.Your Name From :dd/mm/yyyyBusiness NameBusiness AddressBusiness NumberTo:dd/mm/yyyyIncomeSales, commissions or feesMinus – Goods and services tax/harmonized sales tax (GST/HST) andProvincial sales tax (if included in sales above)$___________$___________ a- Returns, allowances, and discounts (if included in sales above) $___________Total of the above two lines $___________ $___________ bNet Sales, commissions, or fees (line a minus line b)$___________Reserves deducted last yearOther income$___________$___________Gross Income (total of the above 3 lines)$___________ cCalculation of cost of goods sold (enter business part only)Opening inventory (include raw materials, goods in process, and finished goods)Purchases during the year (net of returns, allowances, and discounts)SubcontractsDirect wage costsOther costsTotal of the above 5 lines$___________$___________$___________$___________$___________$___________Minus – closing inventory (include raw materials,goods in process, and finished goods)$___________Cost of goods sold $___________ $___________ dGross profit (line c minus line d)$___________ ePlease complete bothsides of the document

Expenses (enter business part only)AdvertisingBad DebtsBusiness tax, fees, licenses, dues, memberships, and subscriptionsDelivery, Freight and expressFuel costs (except for motor vehicles)InsuranceInterestMaintenance and repairsManagement and administration feesMeals and entertainment (allowable part only)Motor Vehicle expenses (not including CAA)Office expensesSuppliesLegal, accounting, and other professional feesProperty taxesRentSalaries, wages, and benefits (including employer’s contributions)TravelTelephone and utilitiesOther expensesSubtotalAllowance on eligible capital propertyCapital cost allowanceBusiness use of home$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________$___________Total business expenses $___________ $___________ fNet income (loss) before adjustments (line e minus line f)$___________