PM 09-02-04-b

  1. (FCRC) Use a Non IV-D Support Referral (Form 2355) to refer a Responsible Relative (RR) who does not live with the unit to the Bureau of Collections (BOC) Field Recovery Unit (FRU).
  2. (FCRC) Send a separate Form 2355 for each RR who does not live with the applicant/customer, unless the RRs live together.
  3. (FCRC) Complete and forward Form 2355:
    • at intake for new applicants;
    • when you learn that Form 2355 should have been completed and was not; and
    • to report any changes in RR status.
    1. Use the following guidelines to complete Form 2355:

      revised textItems 1-11, 20-21 - Completion required;
      revised textItems 12-19 - Complete if information is available.

    2. Complete additional Items on Form 2355 as follows:
      • Children Under Age 18 Active with DCFS

        Include the information provided by DCFS on HFS 2378B, Request for Cash, Medical, Food Stamps, relating to the status of the child's natural parents and RR contribution. Complete Item 19 to show the type of legal responsibility DCFS has for the child. 

      • DMHDD Patients Under Age 18

        Attach or include all financial information supplied by DMHDD concerning the RR(s). Include the following information about the child in Item 19: 

        • private or public certified skilled nursing or intermediate care facility; or
        • private or county-operated sheltered care facility; or
        • private residential care facility; or
        • private or public JCAH psychiatric hospital.
  • If the approved DMHDD case is being transferred to another county or office, write in Item 19: "This active case is being transferred immediately to the FCRC or Medical Field Operations (MFO)." 
  • If there is an existing order for support, attach a copy to Form 2355 if available. Also attach readily available copies of divorce decrees, bankruptcies, and income tax returns. 
  1. (FCRC) Budget a payment made directly to a customer from an RR who does not live with them. Enter Code 541 in Item 90 of Form 552.
  2. (BOC/FRU) Sends the FCRC informational copies of any Administrative Support Orders (ASOs). The ASOs direct the RR to make support payments to:

    Bureau of Fiscal Operations
    Cash Management Unit
    P.O. Box 19407
    Springfield, IL 62794-9407

  3. (FCRC) Delete the budgeted payment shown in Item 90 of Form 552 when the informational copy of the ASO is received and the payment is no longer going to the customer.
  4. (FCRC) If the RR makes a support payment to the customer after the ASO was issued, complete Form 3021, Payment Transmittal Slip, and send the payment and completed form to the Cash Management Unit. The RR's name must be included.
  5. (FCRC) Receive decisions reached by BOC/FRU which specify no RR obligation.