Link Illinois Redetermination Form PDF Details

The Link Illinois Redetermination form is a crucial document for individuals in Illinois who are receiving benefits from the Department of Human Services, ensuring the continuation of support such as Supplemental Nutrition Assistance Program (SNAP) benefits and Temporary Assistance for Needy Families (TANF) Cash. The form serves as a comprehensive review of an individual or family's current circumstances, requiring detailed information about all persons living in the household, income from work or other sources, changes in employment, and living arrangements among other aspects. This thorough process is aimed at verifying eligibility for ongoing benefits and must be completed by a specified due date to avoid interruption of assistance. Additionally, the form addresses changes in health insurance for those with an HFS Medical Card, inquires about child support payments, and even touches on childcare expenses to facilitate work or training. Moreover, it asks about school attendance for individuals over 18, monthly medical expenses for those 60 and over or disabled, and convictions involving drug-related felonies for anyone receiving cash assistance. Understanding the nuances of this form is essential, as it impacts the well-being of many Illinois residents by ensuring they continue to receive the critical support they need.

QuestionAnswer
Form NameLink Illinois Redetermination Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslink card recertification, il link login, link card illinois redetermination application, redetermination il online

Form Preview Example

 

State of Illinois

 

 

 

 

 

Department of Human Services

 

 

2(Permanent)

 

 

Redetermination Application

 

 

 

 

 

 

 

Date of Notice:

 

 

Case I.D.:

 

 

Phone:

 

 

Caseload:

 

 

Write your name and address in the space below if not on form.

Your SNAP benefits will end

 

. To keep getting benefits on your regular availability date,

 

 

 

complete, sign and:

 

 

 

return this form in the enclosed envelope by:

 

(Due Date); or

 

 

 

 

 

bring the form with you to your scheduled appointment.

To be considered a valid application, this form must be signed.

If you receive TANF Cash, this form must be completed for your cash benefits to continue.

1. LIST ALL PERSONS LIVING WITH YOU, INCLUDING YOURSELF.

 

 

 

 

 

 

 

 

 

 

EATS WITH YOU

 

FULL NAME

 

BIRTH DATE

 

RELATIONSHIP

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For additional persons, please attach a separate sheet.

 

 

2.

If you receive an HFS Medical Card, has your health insurance changed?

Yes

No

3.

Does anyone get paid for working?

Yes

No If YES, enter their name below. Attach copies of the last 4 pay

stubs if paid weekly, last 2 pay stubs if paid every other week or twice a month, and the last pay stub if paid monthly.

If self-employed, attach your income and expense statement. If someone got tips that are not on their pay stubs, tell us:

Who?

 

and total amount of tips received in the last 30 days. Total Tips $

List the Name of

Everybody Who is

Working

Employer

If a person works more than one job list all the employers.

Rate of Pay

Hours Worked

Weekly

How often is the person paid? Weekly, every 2 weeks, twice a month, monthly, other?

4.

Did anyone start a new job?

Yes

No

5.

Did anyone stop working, or did their job end?

If YES, complete the information above.

Yes

No If YES, enter name, reason, and final pay date.

IL444-4765 (R-05-14) Redetermination Application

Page 1 of 2

Printed by the Authority of the State of Illinois PO #15-0229 12,000 Copies

 

6. During the last 30 days did anyone receive any other income such as Child Support, Social Security, SSI, Unemployment,

VA, Worker's Compensation, contributions, or any other money?

Yes

No

If YES, complete the box below.

Name

Type of Income

Amount

How Often

7. Do you expect any changes in anyone's income or employment?

Yes

No If YES, what is the change?

When do you expect this change to happen?

8. Have you moved or changed your address?

Yes

No If YES, give us your new address.

9. How much is your:

Rent? $

 

Lot Rent? $

 

 

Mortgage? $

 

 

Enter any taxes and homeowner's insurance paid separately $

 

 

Are any of these paid by someone else?

Yes

No

If YES, tell us who and how much:

 

 

 

 

 

10. Did you receive an energy assistance payment of $21 or more this month or in any of the last 12 months from the Low

Income Home Energy Assistance Program (LIHEAP) (in Chicago paid through CEDA)?

Yes

No

 

Answering yes will not reduce your benefits. If no, are you billed separately from your rent or mortgage for heat or air

conditioning, or excess cost for heat or air conditioning?

Yes

No

 

Note: Air conditioning is a window air or central air conditioning unit.

If NO, do you pay any other utilities?

Yes

No

If YES, what utilities?

Does anyone help pay your utilities?

Yes

No If YES, who and what utilities?

11. Does anyone pay child support?

Yes

No If YES, who makes the payments, how much, and how often?

12. Do you pay for someone to care for a child or disabled adult so you can work, look for a job, or receive training?

Yes

No If YES, who is the care for, who provides the care, how much do you pay for the care, and how often?

13.Does anyone who is age 18 or over attend a school, other than a high school, half-time or more? If YES, who?

Yes

No

14. Does someone in your unit who is 60 or older or disabled have monthly medical expenses of $36 or more?

15. Has any person who is receiving Cash assistance from DHS been convicted of a felony involving drugs?

See enclosed page for important information about your application.

Yes

Yes

No

No

SIGNATURE

By signing below, I swear or affirm, under penalty of perjury, the answers on this application are true and correct to the best of my knowledge.

Signature:

 

 

Daytime or Cell Phone Number:

 

Date:

 

 

 

 

 

 

 

IL444-4765 (R-05-14) Redetermination Application

 

 

Page 2 of 2

 

Printed by the Authority of the State of Illinois

PO #15-0229 12,000 Copies

 

 

 

 

 

 

 

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1. The ebt link form involves specific information to be typed in. Ensure that the subsequent blank fields are filled out:

Part no. 1 in filling in redetermination il online

2. Your next step is usually to complete the following blank fields: YES NO, For additional persons please, If you receive an HFS Medical, Yes, Does anyone get paid for working, Yes, If YES enter their name below, stubs if paid weekly last pay, If selfemployed attach your income, and total amount of tips received, Total Tips, List the Name of Everybody Who is, Working, Employer, and If a person works more than one.

Total Tips, If selfemployed attach your income, and If you receive an HFS Medical inside redetermination il online

It is easy to make errors while completing your Total Tips, hence you'll want to reread it prior to when you send it in.

3. Completing Did anyone start a new job, Yes, If YES complete the information, Did anyone stop working or did, Yes, If YES enter name reason and final, IL R Redetermination Application, and Page of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Stage number 3 for filling in redetermination il online

4. The next paragraph requires your involvement in the subsequent places: During the last days did anyone, Yes, If YES complete the box below, Name, Type of Income, Amount, How Often, Do you expect any changes in, Yes, If YES what is the change, When do you expect this change to, Have you moved or changed your, Yes, If YES give us your new address, and How much is your. Be sure that you provide all of the needed information to move further.

If YES give us your new address, During the last  days did anyone, and Do you expect any changes in in redetermination il online

5. Last of all, this final section is what you'll have to complete prior to finalizing the document. The fields at issue are the following: Note Air conditioning is a window, If NO do you pay any other, Yes, If YES what utilities, Does anyone help pay your utilities, Yes, If YES who and what utilities, Does anyone pay child support, Yes, If YES who makes the payments how, Do you pay for someone to care, Yes, If YES who is the care for who, Does anyone who is age or over, and Yes.

Note Air conditioning is a window, Yes, and If YES who is the care for who inside redetermination il online

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