MR #19.14: New Homeless Shelter Standard for Homeless SNAP Households

Illinois Department of Human Services Logo

09/27/19

Summary

  • Effective September 2019, as required by the Agriculture Improvement Act of 2018, this manual release implements a Homeless Shelter Standard of $147 for SNAP homeless households (all members are homeless) that incur or expect to incur shelter costs during the month. The Homeless Shelter Standard is an alternative to the excess shelter deduction for homeless SNAP households that do not receive free shelter throughout the month. Homeless SNAP households that receive free housing and utilities throughout the month are not eligible for the deduction. A homeless SNAP household may be an individual or several members living together.
  • Effective October 2019, the Homeless Shelter Standard will increase to $152 due to the SNAP Cost of Living Adjustments (COLA) to the maximum allotments, income eligibility standards, and deductions.
  • Active homeless SNAP households that are approved with the Homeless Shelter Standard of $147 in September will have October benefits calculated using $152 as a deduction.
  • A homeless SNAP household which uses the special standard is NOT entitled to the standard utility allowance or the excess shelter deduction. This includes a homeless SNAP household with a qualifying member.
  • SNAP households in general are not required to verify shelter or utility costs. Homeless SNAP households with shelter costs higher than the Homeless Shelter Standard have the option to claim actual costs under the excess shelter deduction instead of claiming the Homeless Shelter Standard, if actual costs are higher and can be reasonably verified. For homeless SNAP households, verification of the shelter expenses is not required to allow the Homeless Shelter Standard. The homeless household must verify the expense if actual shelter costs are claimed.
  • Apply this policy change to homeless SNAP households who incur shelter expenses during the month for initial applications, redeterminations (REDEs) and Mid-Point Reports processed on or after September 26, 2019.
  • IES system changes are effective 09/27/19. IES will allow the homeless shelter deduction in the SNAP budget starting September 2019. An HSC cannot enter homeless shelter expenses prior to September 2019.
  • ABE is currently being modified to capture the homeless shelter questions. Until the work is complete, staff must review the application and follow-up on any additional information needed for shelter expenses. Staff will be notified when the work has been completed.
  • The Program Standards chart WAG 25-03-02 (pdf) is revised with the new SNAP Homeless Standard.
  • Form 683B, SNAP Calculation Sheet is being revised to include a deduction of the Homeless Shelter Standard or the Actual Homeless Shelter Expense in the calculation. Staff will be notified when Form 683B is available on OneNet.
  • Form 360c, Notice of Decision is revised to include the Homeless Shelter Standard and the Actual Homeless Shelter Expenses in the SNAP calculation.
  • Included with this release is a revision to WAG 25-06-02, and WAG 25-06-18 that were inadvertently omitted from Manual Release #19.13: Increase in TANF Payment Levels, dated 09/16/19 and WAG 25-06-05 omitted in Manual Release #19.12: October 2019 Increase in SNAP Allotments, Utility Standards, Income and Deduction Standards, dated 08/21/19. 

Introduction

  1. Homeless Shelter Standard
  2. Option to Use Actual Homeless Shelter Expenses
  3. Homeless Shelter Expenses
  4. Homeless Definition
  5. ABE/IES System Changes
  6. Implementation
  7. Form Revisions
  8. SNAP Calculation Examples
  9. Miscellaneous Manual Page Revision
  10. Manual Revisions
  11. Forms referenced:


Many homeless households have no income and therefore qualify for the maximum SNAP benefit. A Homeless Shelter Standard can be beneficial to those homeless SNAP households that have some income and incur shelter costs during the month by allowing a standard shelter deduction from their income without verifying the expense. Not like the excess shelter deduction which only helps a household whose shelter costs is 50 percent or more than their monthly income after deductions, a homeless shelter deduction can help a homeless SNAP household that incurs or expects to incur shelter expenses during the month. This can result in an increase in benefits for homeless households that are not receiving the maximum SNAP benefit amount.

Apply this policy change to initial applications, redeterminations (REDE), and Mid-Point Reports (MPR) processed on or after September 27, 2019 for homeless SNAP households who incur shelter expenses during the month.

Homeless Shelter Standard

  • A change in the Agriculture Improvement Act of 2018 requires States to provide a Homeless Shelter Standard to homeless SNAP households in which all members are homeless and the household:
    • is not receiving free shelter throughout the month; and
    • does not opt to claim an excess shelter deduction.
  • Effective for September 2019, a homeless SNAP household that incurs or expects to incur shelter costs of $147 or less during the month qualifies for the Homeless Shelter Standard. Homeless households that receive free housing and utilities throughout the month are not eligible for a shelter deduction.
  • Effective for October 2019 and ongoing, the Homeless Shelter Standard is increased to $152 due to the Cost of Living Adjustments (COLA) to the SNAP maximum allotments, income eligibility standards, and deductions.
  • Active homeless households that qualified for the Homeless Shelter Standard of $147 in September will have October benefits calculated using $152 as a deduction.
  • A homeless SNAP household which uses the special standard is NOT allowed to have its shelter expenses considered as part of the excess shelter deduction (PM 13-01-08) or the standard utility allowances (including the Telephone Standard) in the SNAP calculation. This includes a homeless household with a qualifying member. Verification of the expenses is not required. Accept the customer's statement when the shelter expenses claimed do not exceed the Homeless Shelter Standard.

Option to Use Actual Homeless Shelter Expenses

The Agriculture Improvement Act also allows homeless SNAP households who incur or expect to incur shelter expenses in excess of the Homeless Shelter Standard the option to use their actual costs under the excess shelter deduction instead of claiming the Homeless Shelter Standard, if actual costs are higher than the standard and verified. A homeless household choosing to use the excess shelter deduction may also qualify for a utility allowance, if a utility expense is incurred.

Example: Mr. H and his family are homeless. Mr. H receives SSA for himself and his children of $1800 monthly. They are living at the Circle Ranch camp ground that charges $25 daily to stay there plus an additional $35 daily for electric and water. Mr. H has receipts for the payments that he has made to the camp ground. He may use his actual shelter expenses as a deduction for SNAP. Mr. H qualifies for the Actual Homeless Shelter Expense of $750 = ($25 x 30 days). Because he pays for electric (not air or heat) and water, the Limited Utility Standard is allowed.

  • SNAP households in general are not required to verify shelter expenses or utilities. For a homeless SNAP household, verification of shelter expenses is not required, unless actual costs are claimed. Verification of actual costs may include but not limited to receipts, contact with a third party, or a statement by the household providing temporary lodging. For example, if a homeless SNAP household must pay to stay at a homeless shelter, a statement from the shelter is sufficient documentation of the expense. The statement may be written or the FCRC may contact the shelter by telephone and document in case comments. However, the FCRC should keep in mind that homeless SNAP households have fluctuating living arrangements and may not be able to keep up with all the receipts or paperwork needed to verify their expenses. In some instances, the household may not receive any form of documentation for their shelter costs. The FCRC should consider the household's circumstances and accept any reasonable verification.
  • If a homeless SNAP household claims actual costs for shelter expenses but verification of the actual costs is not provided, the Homeless Shelter Standard is used in the SNAP calculation. The SNAP EDG is NOT denied or canceled due to failure to provide verification of the expense.
  • If after the homeless SNAP household is approved for benefits, Actual Homeless Shelter Expenses are verified, treat the expense as a reported change in circumstances. Increase benefits for the fiscal month following the fiscal month that the change is reported. Issue supplemental benefits if it is not possible to include the increase in the regular issuance.

Homeless Shelter Expenses

Homeless shelter expenses are expenses that a homeless household incurs due to being homeless. Examples of homeless shelter expenses may include current payments to a:

  • homeless shelter facility; or
  • hotel for temporary lodging; or
  • payments to family or friends in exchange for temporary housing (must be less than 90 days).

Homeless Definition

For SNAP, a homeless individual is a person who lacks a fixed and regular nighttime residence or a person whose primary nighttime residence is a:

  • supervised shelter that provides temporary accommodations; or
  • halfway house or similar facility that provides temporary residence for persons intended to be institutionalized; or
  • place not normally recognized as a place to sleep (a hallway, bus station, library, car, etc.); or
  • temporary stay in the residence of another person. Persons are considered homeless for no more than 90 days when they are residing temporarily in the home of another person.

To qualify for the Homeless Shelter Standard or the use of Actual Homeless Shelter Expenses, all members in the SNAP household must be homeless and living together.

ABE/IES System Changes

  • ABE is currently being modified to capture the homeless shelter questions. Until the work is complete, staff must review the application and follow-up on any additional information needed. Staff will be notified when the work has been completed.
  • IES system changes are effective 09/27/19. IES will begin budgeting the homeless shelter deduction September 2019. An HSC cannot enter a homeless shelter deduction in IES before September 2019. Some IES screens have been modified to gather information for a homeless SNAP household's  shelter expenses. So that IES can perform the SNAP calculation correctly, the HSC must ensure that the appropriate entries have been entered on the screens. The following table shows the IES screens and the error messages when information is not entered correctly.
 IES Screens Worker Action Validation Field IES Results 
Household Address Screen If both the address AND living arrangement are marked as a type homeless. Allows the Homeless Shelter Standard or Actual Homeless Shelter Expenses in the SNAP calculation.
Household Address Screen Answers "Yes" to the question  "Is the primary applicant homeless?" 

If the living arrangement is not marked as one of the living arrangement type, displays validation message:

"You have indicated that the primary applicant is homeless. Please update the Living Arrangement screen with one of the following living arrangement types: Halfway House, Homeless, Homeless Shelter, Temporarily Living with a Friend or Relative."

Household Address Screen Answers "Is the primary applicant homeless?" as "Yes" for a physical address type.

Upon click of Save + Continue, Save + Previous, or Save + Add Address, displays hard stop message:

"A physical address cannot be saved if the primary applicant is homeless, please update the address type to mailing."

Household Address Screen Answers "Is the primary applicant homeless?" as "Yes" for the mailing address.

"Displays the following message upon click of Save + Continue, Save + Previous, Save + Add Address (this does not prevent the user from advancing):

"You have indicated that the primary applicant is homeless. Please update the Living Arrangement screen with one of the following living arrangement types: Halfway House, Homeless, Homeless Shelter, Temporarily Living with Friend or Relative."

Household Address Screen Changes the response to the question "Is the primary applicant homeless?" from "Yes" to "No".

Displays the following message upon click of Save + Continue, Save + Previous, Save + Add Address:

"You have indicated that the primary applicant is no longer homeless. Please update the Living Arrangement to be no longer homeless and end date any homeless shelter expenses."

Living Arrangement Screen Selects one of the following Living Arrangement Types for the head of household: "Halfway House", "Homeless", "Homeless Shelter", "Temporarily Living with a friend or relative."

If the household address is not homeless, displays validation message once the record is saved:

"The living arrangement chosen indicates that the individual is homeless. Please verify on the Household Address screen that the question "Is the primary applicant homeless?" is marked as "Yes."

Shelter Expense Detail Screen Circumstance Start/Change Date must be 9/1/19 or after to choose Homeless Shelter Standard or Actual Homeless Shelter Expenses.

If the shelter expense type is "Actual Homeless Shelter Expense" or "Homeless Shelter Standard" and Circumstances Start Change Date is before September 1, 2019, displays message:

"The CSCD date cannot be before 09/01/2019 for homeless shelter expenses."

Allows the Homeless Shelter Standard or Actual Homeless Shelter Expenses in the SNAP calculation.
Shelter Expense Detail Screen Under Expense Information, select Expense Type as either "Homeless Shelter Standard" or "Actual Homeless Shelter Expenses", whichever is applicable to the SNAP household.

If the shelter expense type is "Actual Homeless Shelter Expense" or "Homeless Shelter Standard" and the household is not indicated as homeless on the Household Address screen, displays message:

"A homeless shelter expense cannot be added unless the question "Is the primary applicant homeless?" is "Yes"on the Household Address Screen."

If the shelter expense type is "Actual Homeless Shelter Expense" or "Homeless Shelter Standard" and living arrangement is not set as "Halfway House", "Homeless", "Homeless Shelter", or "Temporarily Living with a friend or relative", displays message:

"A homeless shelter expense cannot be added unless the head of household living arrangement is set as "Halfway House", "Homeless", "Homeless Shelter", or "Temporarily Living with a friend or relative" on the Living Arrangement screen."

Defaults to "Monthly" if the shelter expense type is "Homeless Shelter Standard." 
Shelter Expense Detail Screen If actual homeless shelter expenses are used, enter the amount in the "Amount" field.

If the worker adds the Actual Homeless Shelter Expenses and enters an amount less than or equal to the Homeless Shelter Standard, displays message:

"Actual Homeless Shelter Expenses must be greater than the (amount of the Homeless Shelter Standard). Please add the Homeless Shelter Standard if expenses are (amount of Homeless Shelter Standard or less)."

If the household already has the Homeless Shelter Standard OR Actual Homeless Shelter Expense saved, and the worker tries to add another shelter expense type for the same EDM. This applies when adding multiple expenses to the same individual, or different individuals in the same household, displays message:

"Additional expense types cannot be added if the Homeless Shelter Standard or Actual Homeless Shelter Expense already applies for the household in a given month."

Defaults to the Homeless Shelter Standard, if the shelter expense type is "Standard Homeless Shelter."
Shelter Expense Detail Screen Select customer statement in the "Verification" field.

Worker adds expense type for Actual Homeless Shelter Expense, and adds the following verification types: Leaser/Rent Receipt, Phone call to landlord, Lease, Mortgage Statement, Insurance Document, Property Tax Bill, Conversion, displays hard stop message:

"This is not an acceptable verification for the Actual Homeless Shelter Expense."

Defaults to "Client Statement" if the shelter expense type is "Homeless Shelter Standard." 
Shelter Expense Detail Screen The HSC has existing shelter expenses and tries to add Actual Homeless Shelter Expenses or Homeless Shelter Standard to the same EDM.

Displays message upon click or Save + Add Shelter Expenses:

"Please end date all other shelter types before adding homeless shelter expenses for the same time period."

Utility Standard Screen The SNAP Homeless Shelter Standard is saved as an expense on the Shelter Expenses Screen for any given eligibility determination period and HSC navigates to this screen.

Displays the following message upon loading this screen (this does not prevent HSC from entering utility expenses or navigating past screen):

"Utility expenses entered on this page will not be budgeted before (end date of Homeless Shelter Standard) for SNAP because the household is receiving the Homeless Shelter Standard. (If there is no end date for the Homeless Shelter Standard, an end date will not display in the message)."

Standard Allowance Details Summary Screen

If the SNAP household claims "Actual Homeless Shelter Expenses" and a utility expense is incurred as a shelter cost, select the applicable expenses. 

IES applies the appropriate Utility Standard in the SNAP calculation based on the utilities the worker selects.

The Homeless Shelter Standard is saved as an expense on the Shelter Expenses page for the same time period as the utility expenses are added to IES. If the worker tries to enter utility expenses with the Homeless Shelter Standard, displays message:

"Utility expenses entered on this page will not be budgeted for SNAP because the household is receiving the Homeless Shelter Standard."

SNAP EDG Summary Screens
  • Only displays on SNAP EDG Summary. Does not show on Cash and Medical EDG screens.
  • Displays "SNAP Homeless Household" if the SNAP household is homeless based on the Living Arrangement and Household Address Screen.
  • Displays "SNAP Standard Homeless Shelter Deduction" if the SNAP household qualifies for the Homeless Shelter Deduction.
  • Displays 'Y' if the SNAP Household qualifies for the Homeless Shelter Standard and 'N' if the household does not qualify for the Homeless Shelter Standard.
EDG Net Income Results
  • When "Homeless Shelter Standard" is selected as an expense type, displays  "Homeless Shelter Standard" in the field description.
  • When "Actual Homeless Shelter Expense" is selected as an expense type and an amount that is more than the Homeless Shelter Standard is entered, displays as an "Excess Shelter Deduction" in the field description. HSC clicks on the hyperlink to see what expenses were used.

Implementation

 A homeless SNAP household may be an individual or several members living together. All homeless SNAP households must be made aware of the Homeless Shelter Standard and their option to use Actual Homeless Shelter Expenses if they incur or expect to incur shelter expenses during the month. A homeless SNAP household cannot claim both the excess shelter deduction (actual expenses) and the Homeless Shelter Standard.

Determining What to Allow (Homeless Shelter Standard or Actual Shelter Expenses)

  1. Review the application or Mid-Point Report to identify a homeless household.
    1. At the initial application or REDE interview, ask if homeless shelter expenses are incurred at any time during a month. The shelter expenses do not need to be for a full month or for every single month. If expenses are incurred, explain the Homeless Shelter Standard and the use of Actual Homeless Shelter Expenses to the customer. If the customer indicates homeless shelter expenses are incurred of less than or equal to the Homeless Shelter Standard and all other eligibility requirements are met, no further action is needed. The household qualifies for the Homeless Shelter Standard. The customer's statement of the expense is sufficient. A Utility Standard allowance is not given because it has already been considered in the Homeless Shelter Standard.
    2. At the Mid-Point Report, review the responses to a reported address change and if homeless is indicated, send Verification Checklist (Form 267) to the customer if verification of Actual Homeless Shelter Expenses are needed.
  2. If the customer indicates they have shelter expenses that exceed the Homeless Shelter Standard, determine which option would be most beneficial to the customer. Using Actual Homeless Shelter Expenses may not always calculate out to the customer receiving more SNAP benefits than if they had used the Homeless Shelter Standard. If the customer opts to use Actual Homeless Shelter Expenses and does not have proof of the expense with them, issue Verification Checklist (Form 267) and request that proof be provided within 10 calendar days.
  3. If verification of the actual expense is not provided, change the Shelter Expense Detail Screen from Actual Homeless Shelter Expenses to Homeless Shelter Deduction and remove the actual dollar amount in the Amount field. See chart above. Do not deny or cancel a SNAP EDG for failure to verify the actual expenses. In general, a SNAP household is not allowed an expense deduction if the required verification is not returned within the 10 day time-frame. However, for SNAP homeless households, the Homeless Shelter Standard is used if verification of Actual Shelter Expenses are not provided. The customer has already indicated that they have expenses that would qualify them for at least the Homeless Shelter Standard.
  4. Determine eligibility using only the expenses that the homeless SNAP household incurs. Do not include back payments on previously owed shelter expenses.
  5. Notice of Decision (Form 360c) is generated upon approval, including the SNAP calculation.

Form Revisions

Program Standards Chart

The Program Standards chart WAG 25-03-02 (pdf) is revised with the new Homeless Shelter Standard.

Notice of Decision (Form 360c)

Form 360c, Notice of Decision is revised to include the Homeless Shelter Standard and the Actual Homeless Shelter Expenses in the SNAP calculation.

SNAP Calculation Sheet (Form 683B)

SNAP calculation Sheet (Form 683B) is being revised to include the Homeless Shelter Standard and the Actual Homeless Shelter Expenses in the calculation. Staff will be notified when Form 683B is available on OneNet.

SNAP Calculation Examples

Homeless Shelter Standard

A homeless SNAP household is not entitled to their actual shelter expenses or a utility standard when determining eligibility and calculating the SNAP benefit amount if the Homeless Shelter Deduction Standard is allowed.

Example: Mr. B files an initial SNAP application on September 2, 2019. He indicates on the application that he is homeless. At the interview, the HSC asks Mr. B about his homeless situation. Mr. B states he is a homeless veteran and receives $600 per month in Veterans' benefits. He states that during the month he sometimes stays in a shelter for adult men and sometimes stays in his car. He states his stay at the shelter is usually the first 6 days of every month after he receives his VA check. He is charged $20 per night. His homeless shelter expenses are $120 per month. He spends the remainder of the month sleeping in his car. The HSC explains the Homeless Shelter Standard of $147 and the use of Actual Homeless Shelter Expenses to Mr. B. Mr. B states his only expense is $120 to the adult shelter. Mr. B qualifies for the Homeless Shelter Standard of $147 for September. No verification of his shelter expense is needed as it is less than $147. If all other eligibility factors are met, the HSC can certify Mr. B's SNAP benefits effective September 2019. The SNAP calculation using the Homeless Shelter Standard for September is as follows:

GROSS INCOME CALCULATION  September 2019
Unearned income    $600
Noncompliance amount    $0
Gross adjusted unearned income   $600
Gross earned income  +  $0
Total Earned Income + Unearned Income =  $600
Child support deduction -   $0
Total Gross Income =   $600
Gross Monthly Income Standard for Household of 1 $1670
NET INCOME CALCULATION
Earned Income Deduction:
Gross earned income x .80 (round up)   $0
Gross adjusted unearned income +   $600
 Total Adjusted Income =  $600
OTHER INCOME DEDUCTION:
Standard deduction $157 
Dependent care deduction $0 
QM's excess medical expense $0 
Child support deduction $0 
Total Other Income Deductions -   $157
    Adjusted Net Income =   $443
HOMELESS SHELTER STANDARD -  $147
SHELTER DEDUCTION
Rent or Mortgage Expense $0
Property Insurance/Taxes + $0
Total Housing Costs (drop cents) = $0
ACTUAL HOMELESS SHELTER EXPENSES $0
UTILITY STANDARD + $0
Total Shelter Expenses = $0
1/2 of Adjusted Net Income - $0
Excess Shelter Expense* =  $0 
NET SNAP INCOME =  $296
SNAP BENEFIT AMOUNT $103

Note: Mr. B is not allowed the excess shelter deduction or a utility standard. Mr. B is eligible for $103 in SNAP benefits. The Homeless Shelter Standard is $147 for September. Effective October the Homeless Shelter Standard is increased to $152.

Actual Homeless Shelter Expenses

A homeless SNAP household may claim actual shelter expenses if more than the Homeless Shelter Standard amount and it is verified.

Example: Ms. J files an application for SNAP on September 2, 2019. At the interview Ms. J states she works part time at the local diner earning an average of $400 a month. Ms. J marked on her application that she is homeless and explains that she is temporarily staying with a friend in her apartment. When asked by the HSC how long she would be staying with the friend, Ms. J anticipated her stay to be less than 90 days. Ms. J states she sleeps on the couch and is expected to pay her friend $200 monthly. Part of the payment ($50) is used towards Ms. J's  use of the utilities which includes electricity (air conditioning). The HSC explains the Homeless Shelter Standard to the customer and the option to use Actual Homeless Shelter Expenses, if the expense exceeds $147. In this example, the customer would qualify for the Actual Homeless Shelter Expense of $150 and the Air Conditioning Heating Standard, if actual expenses are verified. If the customer opts to use actuals, the HSC gives Ms. J Verification Checklist (Form 267) requesting verification of the actual expense amount and what the expense covers within 10 calendar days. Ms. J provides the verification within the 10 day time frame. Her SNAP benefits are calculated for September using the Actual Homeless Shelter Expenses as follows:

GROSS INCOME CALCULATION  September 2019
Unearned income       $0
Noncompliance amount     $0
Gross adjusted unearned income   $0
Gross earned income   +  $400
Total Earned Income + Unearned Income   =  $400
Child support deduction  -    $0
Total Gross Income   =  $400
Gross Monthly Income Standard for Household of 1 $1670
NET INCOME CALCULATION
Earned Income Deduction:
Gross earned income x .80 (round up)      $320
Gross adjusted unearned income   +   $0
Total Adjusted Income   =  $320
OTHER INCOME DEDUCTION:
Standard deduction $157
Dependent care deduction $0
QM's excess medical expense $0
Child support deduction $0
Total Other Income Deductions   -  $157
Adjusted Net Income   =  $163
HOMELESS SHELTER STANDARD $0
SHELTER DEDUCTION
Rent or Mortgage Expense $0
Property Insurance/Taxes + $0
Total Housing Costs (drop cents) = $0
ACTUAL HOMELESS SHELTER EXPENSES $150
UTILITY STANDARD + $466
Total Shelter Expenses = $616
1/2 of Adjusted Net Income - 81
Excess Shelter Expense*   - $535
NET SNAP INCOME    = $0
SNAP BENEFIT AMOUNT   $192

Note: Ms. J is eligible for $192 in SNAP benefits using her Actual Homeless Shelter Expenses. If she had not returned the verification, the Homeless Shelter Standard would be used in the calculation. Do not deny or cancel a SNAP EDG for failure to verify actual expenses. In general, a SNAP household is not allowed an expense deduction if the required verification is not returned within the 10 day time-frame. For SNAP homeless households, the Homeless Shelter Standard is used if verification of Actual Shelter Expenses are not provided because the customer has already indicated that they have expenses of at least the Homeless Shelter Standard amount. 

Miscellaneous Manual Page Revision

Included with this release is a revision to WAG 25-06-02, and WAG 25-06-18 that were inadvertently omitted from Manual Release #19.13: Increase in TANF Payment Levels, dated 09/16/19 and WAG 25-06-05 omitted in Manual Release #19.12: October 2019 Increase in SNAP Allotments, Utility Standards, Income and Deduction Standards, dated 08/21/19. 

Manual Revisions

[signed copy on file]

Grace B. Hou

Secretary, Illinois Department of Human Services

Forms referenced:

Form 267 VCL

Form 360c

Form 683B