PM 21-01-05-b

An applicant or client must sign Consent to Release Form (Form 34) before the FCRC may contact a 3rd party to obtain:

  • proof of the claim of domestic new textor sexual violence, or
  • information related to domestic new textor sexual violence services.

Form 34 must specify the information to be released. Use the following wording when completing the form:

revised TextThe Illinois Department of Human Services is requesting verification of (name) claim of domestic or sexual violence. This information will be used in the development of (name) Responsibility and Services Plan and to determine eligibility for a Family Violence Exclusion.