DHS-431, Self-Employment Income and Expense Statement

What Is DHS-431 Self-Employment Statement Form

What is DHS 431 self-employment statement used for

The DHS-431 is the Michigan Department of Health and Human Services (MDHHS) form on which a self-employed household reports its business income and expenses for one month. MDHHS uses it as one of the ways to verify self-employment income when it decides eligibility and benefit amounts for Food Assistance (FAP), cash assistance (FIP, SDA, RCA) and child care (CDC). It is not accepted as verification for Medicaid: for Medicaid, MDHHS uses your tax return or your business records. Income from an S corporation or an LLC is not self-employment for MDHHS and is verified differently. The form's purposes:

• reporting self-employment income: you list each source of income received in the month, with the date and amount;
• documenting business expenses: you list the expenses of running the business if you want MDHHS to count your actual expenses;
• evaluating eligibility: MDHHS uses the statement to work out your countable self-employment income.

Your filed tax return is MDHHS's primary source when it still represents your income; the DHS-431 with income receipts is the secondary source, and the DHS-431 without receipts the third. The template on PDFLiner gives you the same one-page form to fill in and print.

How to Fill Out DHS-431

Section 1: Business Information

• Name of Business and Name of Business Owner: enter your DBA or sole-proprietorship name and your own name
• Address of Business and Type of Business: the physical location (your home address if home-based) and what the business does
• Number of Hours Worked in Month: the hours you worked in the month the form covers

Section 2: Income for the month

Write the month the statement covers at the top, then list every source of self-employment income received in that month, the date received and the amount:

• Client payments and invoices paid
• Cash transactions (keep a record of them)
• Online sales and digital services
• Seasonal or irregular income (MDHHS averages income over the months it covers, not automatically over 12 months)

💡 Pro Tip: Use bank statements and payment processor reports (PayPal, Stripe, Square) to support the amounts you enter.

Section 3: Expenses

Complete Section 3 only if you want MDHHS to count your actual expenses, and attach proof of each one. If you do not provide proof, MDHHS applies a standard expense allowance instead: for FAP, FIP, SDA, RCA and CDC the allowable expenses are the higher of 50 percent of your total proceeds or your verified actual expenses. For FAP, FIP, SDA, RCA and CDC, MDHHS does not allow these business expenses: federal, state and local income taxes, depreciation, a net loss from a previous period and retirement set-asides. The form lists the expense types: merchandise and raw materials, loan interest and principal on business equipment or property, insurance on those loans, taxes on income-producing property, on-the-job transportation (not commuting), capital equipment, wages paid to employees, advertising, postage, rent and utilities for business space, and other expenses you name.

Common Mistakes to Avoid

1. Mixing personal and business expenses - Only report business costs
2. Forgetting cash income - All income must be reported, even cash
3. Using figures that no longer represent your business - MDHHS uses your last tax return when it still reflects your income, and the DHS-431 for the month asked
4. Claiming actual expenses without proof - Without receipts MDHHS uses the standard allowance, so attach proof if your real expenses are higher

How to report self-employment income

When reporting self-employed income using the DHS-431 form, consider the following sum-it-all-up useful tips from our experts. First, maintain accurate records of all your income and business expenses to ensure accurate reporting.

Second, in the Income and Expense statement PDF, report all sources of self-employment income and provide comprehensive details of business expenses. Third, include receipts and invoices if you claim actual expenses, and send the signed statement with the proof to your MDHHS specialist (through MI Bridges, in person or by mail). Finally, if you're unsure about specific entries or deductions, ask your MDHHS specialist or a reliable tax professional for guidance.