Form Il444 4469 PDF Details

Form Il444 4469 is an informational form that businesses in Illinois must use to report the sale or transfer of any liquor, wine, or beer. The form must be submitted to the Illinois Liquor Control Commission within five days of the sale or transfer. This form is used to keep track of alcohol sales and prevent illegal activities such as underage drinking and smuggling. Failure to submit this form may result in fines and other penalties. Make sure you are familiar with Form Il444 4469 and know how to correctly complete it before making any liquor, wine, or beer sales or transfers.

Form NameForm Il444 4469
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesHancock, Sangamon, R-10-11, il444 4469

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State of Illinois

Department of Human Services

Child Care Rate Certification Form

Please complete this form and return to your Child Care Resource and Referral Agency (CCR&R). A listing of the counties served by each CCR&R, their address and phone number is on the back of this page.

Child Care Provider Information


Doing Business As:


City, State, Zip:

Provider Social Security Number (SSN) or

Federal Employer Identification Number (FEIN):

County in which care is provided:

Phone Number:








Fax Number:

























E-Mail Address:







































Type of Care:


760 Licensed Center



Licensed Home
















761 Licensed-Exempt Center


Licensed Group Home





DCFS Day Care License Number:








(Not Foster Care License Number)
















License Expiration Date:

Hours of Operation: From



License Capacity:

























































Daily Rates










Effective Date of Rates Below:

Check if you have a separate rate sheet. A copy of your rate sheet must be attached. This can be done to accomodate different rates.

Under Age 2

Age 2

Age 3 and Older

Full-Day Rate (5-12 hours per day)

Part-Day Rate (less than 5 hours per day)

School Age Rate (for centers only)

Do you have any discounts (such as multiple child discounts, staff discounts, full-week discounts, pre-pay discounts, or sliding fee scales)? If yes, list the type and amount of your discounts.

I certify that the information provided is true, correct, and complete. I also certify that the rates charged to the State of Illinois do not exceed the maximum allowed by the State and do not exceed the rates I charge to the general public for similar services. This includes discounts such as multiple child discounts, staff discounts, full-week discounts, pre-pay discounts, and sliding fee scales. I understand giving false information or failure to provide correct information can result in referral for prosecution for fraud.


















IL444-4469 (R-5-12) Child Care Rate Certification Form




Printed by Authority of the State of Illinois P.O. #12-1386 6,200 copies


Page 1 of 2

State of Illinois

Department of Human Services

Child Care Rate Certification Form

IDHS Child Care Assistance Program - CCR&R List

Counties Served & CCR&R

Counties Served & CCR&R






Coles, Clark, Cumberland, Edgar, Moultrie & Shelby


Action for Children

Child Care Resource & Referral


Child Care Assistance Program

Eastern Illinois University


1340 S. Damen Ave.

600 Lincoln


Chicago, IL. 60608

Charleston, IL. 61920


(312) 823-1100

(800) 643-1026





Boone, Jo Daviess, Stephenson & Winnebago

Adams, Brown, Calhoun, Cass, Greene, Hancock, Jersey, Pike


YWCA Child Care Solutions

& Schuyler


Child Care Assistance Program

West Central Child Care Connection


4990 E. State St.

510 Maine, Room 610


Rockford, IL. 61108

P.O. Box 610


(815) 484-9448 or (800) 872-9780

Quincy, IL. 62306



(217) 222-2550


Carroll, DeKalb, Lee, McHenry, Ogle & Whiteside




Christian, Logan, Macoupin, Mason, Menard, Montgomery,


Community Coordinated Child Care (4-C)


155 N. Third St., Suite 300

Morgan, Sangamon & Scott


DeKalb, IL. 60115

Community Child Care Connection, Inc.


(800) 848-8727 Ex. 225

919 S. Spring St.



Springfield, IL. 62704



(217) 525-2805




YWCA of Lake County



Child Care Resource & Referral Service

Henderson, Henry, McDonough, Mercer, Knox, Rock Island


2133 Belvidere Rd.

& Warren


Waukegan, IL. 60085

Community Child Care Resource & Referral


(847) 662-6129

500 East 59th St.



Davenport, IA. 52807


DuPage & Kane

(800) 923-7844


YWCA Child Care Resource & Referral



Bond, Clinton, Madison, Monroe, Randolph. St. Clair


Child Care Assistance Program


55 E. North Ave.

& Washington


Glendale Heights, IL 60139

CHASI-Child Care Resource & Referral


(630) 790-8009

2133 Johnson Rd. Suite 100A



Granite City, IL. 62040




Grundy, Kankakee, Kendall & Will

(800) 847-6770


Child Care Resource & Referral



801 N. Larkin, Suite 202

Clay, Crawford, Edwards, Effingham, Fayette, Jasper,


Joliet, IL. 60435

Jefferson, Lawrence, Marion, Richland, Wabash & Wayne




(800) 641-4622

Project CHILD





Rend Lake College




Bureau, Fulton, LaSalle, Marshall, Peoria, Putnam, Stark,

P.O. Box 827




Tazewell & Woodford

Mt. Vernon, IL. 62864




SAL Child Care Connection

(800) 362-7257




3425 N. Dries Lane





Peoria, IL. 61604

DeWitt, Ford, Livingston & McLean


(800) 421-4371

Child Care Resource & Referral Network



207 W. Jefferson, Suite 301


Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson,


Bloomington, IL. 61701


Johnson, Massac, Perry, Pulaski, Pope, Saline, Union, White

(800) 437-8256


& Williamson



Child Care Resource & Referral

Champaign, Douglas, Iroquois, Macon, Piatt & Vermillion


John A. Logan College

Child Care Resource Service


Carterville, IL. 62918

Child Care Assistance Program


(800) 548-5563

314 Bevier Hall, 905 S. Goodwin



Urbana, IL. 61801



(800) 325-5516





IL444-4469 (R-5-12) Child Care Rate Certification Form


Printed by Authority of the State of Illinois P.O. #12-1386 6,200 copies

Page 2 of 2

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Peoria conclusion process outlined (step 1)

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