PM 02-04-01

Make applications available in all FCRCs and to outreach groups and organizations involved in the outreach efforts.

Tell the person to complete the form to show at least a name, address, and signature, and to return the application as soon as possible.

Keep the applications in an area where the receptionist or other FCRC staff can hand them out.

Make Spanish language applications available for SLUs.

Determine eligibility for expedited SNAP benefits according to PM 02-08-00 and WAG 02-08-00. This includes initial SNAP applications taken in Service Coordination.

Explain to each applicant that the Department determines their eligibility for all programs unless they indicate in writing that they do not want to apply for a particular program(s).

When a person contacts the FCRC by phone or mail to request an application, mail the application packet on the date that the request is received. Issue Instructions to Client (Form 267) at this time. Check only the information needed. For Parent Assist and All Kids Assist applications, use Form 267E or Form 267F. Along with Form 267, send the applicant Applying for Benefits (Form 565N).

Give any person who wants to apply for assistance informational pamphlets and the chance to apply.

At the time of application, give the client the following forms:

  • SNAP Program (Form 124);
  • SNAP Program (Form 124D);
  • Guide To Your SNAP Rights (Form 4762);
  • Instructions to Client (Form 267, Form 267E, Form 267F) (not QMB Only or SLIB Only cases);
  • Guide to Services (Form 4474);
  • Appeals and Fair Hearings For Public Assistance Clients (Form 377);
  • Your Civil Rights (Form 592); and
  • Applying for Benefits (Form 565N).

Review the application and determine for which benefits the applicant is applying. If necessary, discuss the options available to the applicant. Complete the Application Confirmation (Form 400), sign it, and provide it to the applicant. Form 400 is not required for Web applications, Web applicants are given electronic confirmation after they submit their application.

Give all clients applying for AABD:

  • Aid to the Aged, Blind or Disabled/AABD (Form 587);
  • Medicaid (Form 591);
  • Medicaid Payment of Medicare Cost Share Expenses (Form 3120); and
  • Property Liens and Estate Claims (Form 3419B).

Give all clients applying for category 93 with a child under age 18, and an absent parent, forms:

  • Instructions for Paternity Establishment, Cash or Medical Benefits (Form 267D);
  • Notice Concerning Good Cause for Refusal to Cooperate (Form 1260A);
  • Child Support Enforcement Program (Form 1759); and
  • Valid Reasons for Missing a Child Support Enforcement Appointment (Form 3017).

Issue the following to applicants for TANF and all Family Health Plans:

  • Instructions for Paternity Establishment, Cash or Medical Benefits (Form 267D) (not required for applicants who apply on Form 2378KC or Form 2378MC);
  • Temporary Assistance For Needy Families (Form 586) (TANF applicants only);
  • Medicaid (Form 591);
  • Healthy Kids (Form 1123);
  • Notice Concerning Good Cause for Refusal to Cooperate (Form 1260A);
  • Child Support Enforcement Program (Form 1759) (not required for applicants who apply on Form 2378KC or Form 2378MC);
  • Verification of Pregnancy (Form 2304) (if needed);
  • Redetermination Fact Sheet (Form 2604) (TANF applicants only);
  • Valid Reasons for Missing a Child Support Enforcement Appointment (Form 3017) (not required for applicants who apply on Form 2378KC or Form 2378MC);
  • Affordable Child Care (Form 3211);
  • In Illinois, Work Pays (Form 3496) (TANF applicants only);
  • Answers to Your Questions, TANF (Form 4047) (TANF applicants only); and
  • Child Care and the TANF Work Requirement (Form 4336) (TANF applicants only).

Issue the following to TANF applicants:

  • Domestic Violence Exclusion (Form 4710);
  • Opportunities - Education and Training (Form 4708);
  • Opportunities - Going to College (Form 4709).

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Issue the following to employed applicants:

  • Child Care Application (Form 3455).

For persons applying for SNAP benefits also issue:

  • Reporting Changes - SNAP benefits (Form 2777);
  • Expedited/Emergency SNAP Screening Form (Form 401), except for Web applications.

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Issue/complete the following pamphlets/forms as needed:

  • Responsible Relatives (Form 53);
  • Referral And/Or Disposition of Application (Form 221);
  • Request For Employment Verification (Form 266);
  • new textAuthorization to Release Medical Records ( Form 4701H);
  • Release of Medical Information (Form 308);
  • Medical Assistance - Non Spenddown (Form 458);
  • Notice of Determination of Monthly Spenddown/Met/Unmet (Form 458SP);
  • Verification of School Attendance (Form 541);
  • Medicaid Spenddown (Form 591SP);
  • Healthy Kids (Form 1123);
  • Summary of Case Information (Form 1376);
  • Temporary MediPlan Card (Form 1411);
  • Health Insurance Report (Form 1442);
  • Child Support (Form 1760);
  • Report of Child Support (Form 1765);
  • Non IV-D Support Referral (Form 2355);
  • Summary of Medical Expense (Form 2430ASP);
  • Medical Assistance Enrollment Status Information/Changes During the Established Period (Form 2434);
  • Direct Deposit (Form 2493);
  • Special Information for Persons Receiving/Applying for In-home Care Services Through the Department on Aging (Form 2538A);
  • Medical Assistance and Third Party Liability (Form 2875);
  • Nursing Home Services and Information for Couples (Form 3191);
  • Informed Choice (Form 3800);
  • Your TANF Time Limit (Form 4335); and
  • Redetermination Fact Sheet (Form 4769).

The HFS All Kids Unit meets the pamphlet requirements in a different manner.