IX. Forms

The Provider and FCRC staff will use various forms provided by the Department to report and maintain accurate records of each client's activities, hours completed, attendance, progress, etc.

• Referral Form IL444-2151 (pdf)
• Change/Progress Report Form IL444-2151A (pdf)
• TANF Responsibility and Services Planorm IL444-4003 English (pdf)
• TANF Responsibility and Services Plan Form IL444-4003S Spanish (pdf)
• Responsibility and Services Plan Attendance and Activity Report Form IL444-4006 (pdf)
• Work Experience/Work First/Community Service Worksheet Form IL444-4044 (pdf)
• Employment and Training Participant List Form IL444-4333 (pdf)
• Employment and Training Staffing Form IL444-4334 (pdf)
• Reconciliation Appointment Notice Form IL444-2846 (pdf)
• Reconciliation Agreement Form IL444-2846A (pdf)
• Child Care Application Form IL444-3455 (pdf) 
• Child Care Application Form IL444-3455S Spanish (pdf)
• Resource Connections Form IL444-4004 (pdf) 
• Resource Connections Form IL444-4004S Spanish (pdf)
• First Notice Regarding Non-Cooperation with Work First/Work Experience (Form 4125)
• Second Notice Regarding Non-Cooperation with Work First/Work Experience (Form 4126)
• Work First/Work Experience Agreement Form IL444-4484 (pdf)
• Work First/Work Experience Agreement - Provider/Contractor Form IL444-4484C (pdf)