PM 22-12-00

The following forms used to apply or redetermine eligibility contain information about voter's registration and an SBE R-19 Illinois Voter Registration application:

  • Form 643, Your Family's Medical Eligibility Renewal Form
  • Form 643C, AABD Medical Eligibility Review
  • Form 643G/643GC, AABD Redetermination Report Form
  • Form HFS 643E-1, Your Family's Medical Eligibility (Passive REDE)
  • Form 683, Application for Food Stamps
  • Form 1229A, Long Term Care
  • Form 2027AC, Redetermination Report Form (GA-TA) 
  • Form 2378B, Application for Cash, Medical and Food Stamps
  • Form HFS 2378H, Mail-In Application for Medical Benefits
  • Form HFS 2378KCC, Application for All Kids, Family Care, and Moms & Babies Health Insurance
  • Form DPA 3360B Renewal Form (Following Medical Extension) 
  • Form 4002/Form 4002C, TANF/GA-FCA Eligibility Information
  • Form 4765B, Attachment to Application
  • Form 4892, Reapply for Benefits Using the Phone System Interview

Form 1978, Food Stamp Program Change Report Form contains information about voter registration.