WAG 02-04-00: Application

PM 02-04-00

Use the following application forms for the programs indicated:

Form 683 Application for SNAP benefits
Form 2378ABE Application for Health Coverage & Help Paying Costs
Form 2378B

Application for Cash, Medical and SNAP Benefits

Mail-in or DHS web application for all programs.
Form 2378C

Application for Cash, Medical and SNAP Benefits

All programs.
Form 2378H

Mail-in Application for Medical Benefits

Mail-in application for all medical programs. Can also be used by a hospital, long term care facility, or supportive living facility.
Form 2378M Application for Payment of Medicare Premiums, Deductibles and Coinsurances
Medicaid payment for Medicare cost sharing expenses only.
Form 2378MC Application for All Kids, FamilyCare and Moms & Babies Health Insurance
Medical application for Family Health Plans used by All Kids Application Agents.
Form 2431 Application for Medical Assistance - Short Form
Use this application only for persons who were in spenddown status within the last 4 months of the month of application and were centrally canceled due to not meeting their spenddown obligation.
Form 3089 All Kids Moms & Babies (Medicaid Presumptive Eligibility Application)
Mail-in application used by qualified providers.

Application for Benefits Eligibility (ABE)

Applicants submit applications for Cash, Medical, Medicare Savings Program, and SNAP through Application for Benefits Eligibility (ABE) at abe.illinois.gov and the applications are routed to the IES at the correct office and retrieved from the Electronic Document Mangement (EDM) Inbox. ABE auto populates screens in the Integrated Eligibility System (IES) worker portal.

Telephonic Applications

Persons may apply for medical and SNAP benefits over the phone by calling the ABE (Application for Benefits Eligibility) Customer Call Center, located in the Broadway Central Family Community Resource Center (FCRC) #150.

The ABE Customer Call Center accepts applications for Medical and initial SNAP only.  The ABE Customer Call Center does not accept telephonic applications for TANF Cash, AABD Cash, or initial SNAP applications if there is an active categorical case with the same grantee.

The ABE Customer Call Center is accessed by calling the DHS helpline at 1-800-843-6154. Telephonic applications taken by the ABE Customer Call Center are processed in the Integrated Eligibility System (IES). If the applicant is not requesting cash assistance or does not have an active medical case, a new application will be started in IES.  ABE Call Center staff will inform the customer at the beginning of the call that a telephonic signature will be required in order to have a valid application.  If the applicant in non-English/non-Spanish speaking, the ABE Customer Call Center contacts the Translator Bank to assist in completing the application interview.

revised manual textProvide a Copy of the SNAP Application

The FCRC must offer a copy of the completed SNAP application in the format that the SNAP household requests. If the SNAP household completed a paper application, but requests the copy in electronic format, the FCRC must provide the copy in electronic format. See Desk Aid for Encrypting PDF Documents. Until IES is programmed, document in the Case Comments that the customer was offered a copy of their application and the format in which it was provided. Also indicate in the Case Comments when a customer declines the offer.

How to Encrypt PDF Documents

If the PDF to be encrypted is a "fillable" form start with number 1.  If the PDF to be encrypted is not a "fillable" form start with number 3.

  1. Print the PDF out and scan it back to yourself.  Otherwise, the information on the form will be lost.
  2. Once scanned back to yourself, save as a regular PDF in a location on your local drive.
  3. Right click on the PDF file to be encrypted and select "Open With" and "Word 2016".
    • If the following message pops up, just select "OK": "Word will now convert your PDF to an editable Word document. This may take a while..."
  4. Look the document over to be sure no major changes took place during conversion.
  5. Select "File" in the top left hand corner of your toolbar, then "Save As". Change the document type back to PDF, and select "More Options". 
  6. Add the word "Encrypted" to the end of the document name, but in front of ".pdf", then select "Options".
  7. Select "Encrypt the document with a password".
  8. Click Ok.
  9. Create and enter a password, then reenter it. Passwords must be between 6 characters and 32 characters in length.  *Note: Make sure you remember the password.  If you do not remember your password, it is not recoverable. 
  10. Click Ok.
  11. Click Save. 
  12. Send the encrypted PDF to the customer's email address using File Transfer Utility.  The File Transfer Utility is located on the DHS Homepage under Forms, Reports & Tools.