Imfrf Form 2 PDF Details

The Illinois Military Family Relief Fund (IMFRF) Application, specifically the Active Duty Casualty Grant form, is a vital resource for military personnel and their families in times of crisis. Designed to provide financial assistance to those who have been injured in the line of duty, this form encapsulates the state's commitment to supporting its servicemen and women. Recognized by its official designation, IMFRF Form 2, as of 23 November 2009, applicants looking to avail themselves of a flat rate grant of $5000 must meet specified criteria and submit a series of documents, including proof of Illinois residency, service member’s activation orders for a minimum of 60 days post-September 11, 2001, terrorist attacks, and detailed evidence of the injury sustained in combat or as a result of hostile action. The form emphasizes the necessity of presenting clear documentation to substantiate claims, covering everything from Illinois State Income Tax returns to the Department of Defense's official casualty reports. With strict guidelines on eligibility, particularly concerning the injury's occurrence date and nature, the IMFRF application process underscores the importance of accuracy and completeness in submissions. It also outlines conditions for applicant verification, disclosing that social security numbers, while crucial, are provided voluntarily but are essential for grant processing. Additionally, the submission process and the confidential handling of the application, in accordance with state and federal laws, highlight the meticulous care taken to ensure both the privacy of applicants and the integrity of the grant distribution.

QuestionAnswer
Form NameImfrf Form 2
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesLEGIBLY, illinois military family relief fund, BIRTHDATE, MacArthur

Form Preview Example

ILLINOIS MILITARY FAMILY RELIEF FUND (IMFRF) APPLICATION

ACTIVE DUTY CASUALTY GRANT ONLY

If you need assistance completing the application please call within Illinois 1-866-524-ILNG (4564)

or 217-761-3452 from anywhere (DSN 555-3452)

MAIL TO:

Illinois Department of Military Affairs

PLEASE PRINT LEGIBLYATTN: IMFRF Coordinator

1301 N. MacArthur Blvd.

Springfield, IL 62702-2399

Active Duty

Casualty Grant

Applicants Only

The address provided will be the check mailing address. PLEASE ALLOW 4-6 WEEKS FOR PROCESSING.

MILITARY MEMBER’S INFORMATION

DATE OF INJURY: _________________________________

NAME: ____________________________________________________

BIRTHDATE: ______________________

HOME ADDRESS: ________________________________________________________________________________

CITY: ___________________________________________________________________________________________

STATE: _____________________________________ZIP: (Nine Digits if available)______________________________

PREFERRED PHONE NUMBER: ________________________ ALTERNATE PHONE: __________________________

COMPONENT: _____________________ PAY GRADE: _________ SSN: ______________________________

DUTY STATION/UNIT OF ASSIGNMENT: ______________________________________________________________

EMAIL ADDRESS: _________________________________________________________________________________

APPLICANT’S INFORMATION (IF OTHER THAN MILITARY MEMBER)

(If applicant is not the service member’s spouse, applicant must include a copy of a Power of Attorney OR Custodial Agreement for the service member’s minor child)

NAME: ____________________________________________________ SSN: _____________________________

HOME ADDRESS: _________________________________________________________________________________

CITY: ____________________________________________________________________________________________

STATE: _______________________________________ZIP: (Nine Digits if available)____________________________

PHONE: _________________ RELATIONSHIP TO MILITARY MEMBER: __________________________________

MILITARY UNIT POINT OF CONTACT FOR VERIFICATION OF INFORMATION:

NAME: __________________________________________________________________________________________

POSITION/TITLE: __________________________________ PHONE NUMBER: _____________________________

1.I certify that, at the time of deployment the service member listed above was an Illinois resident and a member of the Active Component Service indicated above

2.I certify the above information is true and correct.

3.I authorize verification/release of the information I am providing on this application. I authorize the State of Illinois and the Illinois Department of Military Affairs access to pertinent records, including information maintained in DEERS, REDD or other automated systems, as may be necessary to evaluate my application.

4.Disclosure of information on this form, including social security numbers, is voluntary. Failure to provide the requested information will prohibit the processing of this grant application.

5.In accordance with applicable laws, the State of Illinois and the Illinois Department of Military Affairs will maintain confidentiality regarding the application and any grant given or denied, except as required to process this or subsequent applications, or as otherwise required by law.

SIGNATURE OF APPLICANT: ________________________________________ DATE: _____________________

IMFRF FORM 2 – 23 November 2009

PAGE 1 of 2

ACTIVE DUTY CASUALTY BASED GRANT -- FLAT RATE OF $5000 (MUST INCLUDE ALL DOCUMENTS LISTED)

OMISSION OF ANY OF THE FOLLOWING DOCUMENTS OR INCOMPLETE PREPARATION OF THE FRONT OF

THIS APPLICATION WILL PRECLUDE PROCESSING.

Must include documentation that clearly substantiates Illinois Residency prior to the date injury occurred.

A copy of the preceding years’ Illinois State Income Tax return

Attach a copy of service member’s activation orders reflecting at least 60 consecutive days duty as a

result of the September 11, 2001 terrorist attacks.

Attach Leave and Earnings Statement (LES) or DD214. If sending a LES, it MUST be a minimum 15 days

(i.e. 1 Dec 09 TO 15 Dec 09) and within the period of service on the activation orders.

INJURY MUST HAVE OCCURRED ON OR AFTER 23 November 2009 (Effective Date of Legislation) – Service member must submit documentation (Purple Heart, an approved Line of Duty Investigation or an official DOD casualty report) reflecting that they were injured due to HOSTILE Action as follows in the IMFRF rules:

(Payments cannot be made without such verification.)

NOTE: Only one grant is authorized for injuries received during or arising out of the same incident/engagement.

“Proof that the service member sustained an injury as a result of terrorist activity; sustained an injury in combat, or related to combat, as a direct result of hostile action; or sustained an injury going to or returning from a combat mission, provided that the incident leading to the injury was directly related to hostile action. This includes injuries to service members who are wounded mistakenly or accidentally by friendly fire directed at a hostile force or what is thought to be a hostile force.”

NOTE: The Casualty Based Grant cannot be made on behalf of deceased members as other compensation may be paid by the State of Illinois, Department of Veterans Affairs or Court of Claims.

IMFRF FORM 2 – 23 November 2009

PAGE 2 of 2

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Learn how to prepare BIRTHDATE stage 2

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BIRTHDATE writing process described (step 3)

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