Form 3085, Statement of Self-Employment Income

Instructions for Opening a Form

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Effective Date: 1/2020



Updated: 1/2020



Form 3085 is used by a household member to report self-employment income and expenses if accurate tax or business records are unavailable.


When to Prepare

Complete the Case Record Name and Case Record No. at the top of Page 1. Issue the original to the household member. The household member completes the rest of the form and provides it to the caseworker.


Form Retention

File the completed form in the case record and maintain at least until the end of the third complete state fiscal year following the date on which Form 3085 is submitted.


Detailed Instructions

Page 2 of Form 3085 provides instructions for the household member to complete the form.