Illinois Department of Revenue
2022                IL-W-6-WS 
Worksheet to Report Days Worked in Illinois for Non-Residents
Read this information first: Complete this worksheet to report any days worked in Illinois, beginning on or after January 1, 2022, and 
before January 1, 2023.  
Employees: If you completed 2022 Form IL-W-6, Certificate of Days Worked in Illinois for Non-Residents, you must also complete and 
submit this worksheet to your employer by January 1, 2023, to report the dates and address of locations worked in Illinois. Attach any 
additional sheets in the same format as needed. Do not enter the total on your additional sheets.Please keep a copy of this report for 
your own records. 
Employers: Enter the business name and FEIN and keep this worksheet with your payroll records. You must send us this information if we 
request it. 
Employee name _____________________________________                                                                         SSN ____________________________
Business name _____________________________________                                                                         FEIN ____________________________

            Date worked in Illinois                                                                                         Address of location worked in Illinois
                                                                                                                            include street address and city
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                     Total Days Worked

By signing below, I certify this record of days worked is accurate and complete. 
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Employee’s signature                                                                                                    Date
IL-W-6-WS (R-12/21)                                                                                                         This form is authorized under the Illinois Income Tax Act. Disclosure of this information is required. 
Printed by the authority of the State of Illinois - web only, 1 copy                                                        Failure to provide information may result in this form not being processed and may result in a penalty.