HFS 1376 contains essential information and verifications not likely to change. Along with HFS 552, it gives an overall summary of case information and eligibility factors.

HFS 1376C is a computer generated version of the manual HFS 1376. AIS generates a HFS 1376C for all regular roll (Option 8) approvals statewide, except AABD MANG, after the "Actions To Be Taken Screen". When the HFS 1376C is damaged or full, complete a manual HFS 1376.

NOTE: For AABD cash approvals, request a HFS 1376C print via the Forms Generation Menu Option (Option F) of the Eligibility Subsystem. Family Community Resource Center staff may complete a manual HFS 1376 for AABD cash approvals instead of printing a HFS 1376C.

The system completes all entries on HFS 1376C, based on verified information entered during the eligibility process. When the spaces for a field are full, the system prints a 2nd page. However, eligibility workers must manually complete the following sections on the HFS 1376C:

  • Special Medical Needs - Note,
  • Special Notes by Caseworker, and
  • Language Preference.

The Metro Chicago Zone requires its Family Community Resource Center to keep HFS 1376/HFS 1376C accurate and up-to-date. The following downstate Family Community Resource Centers require the use and maintenance of HFS 1376/HFS 1376C:

Champaign

Kankakee

Lake

Macon

Madison

Peoria

Rock Island

Sangamon

St. Clair

Vermilion

Winnebago

For all other Family Community Resource Centers the LOA or Zone Manager makes the rules about the use of HFS 1376/HFS 1376C.

Review HFS 1376\DPA 1376C before each REDE. The form should be used with HFS 2027, Redetermination of Eligibility. Consider the form as part of the case record materials. Documentation can be done exclusively on the form.

When transferring a case, include HFS 1376/HFS 1376C with the case record. For inter-office transfers the new FCRC must update the form. If the new FCRC gets a case from an FCRC that does not use HFS 1376/HFS 1376C, they must complete the form. Include HFS 1376/HFS 1376C with closed cases.