WAG 02-06-01-d: Form IL444-2378B

PM 02-06-01-d

  • revised manual textUse Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program (SNAP) (IL444-2378B) when:
    • A new customer requests that an application be mailed to them; or
    • A customer requests the application in-person at the FCRC but is unable to stay to complete it; or  
    • The customer is unable to come in for an interview; or
    • The IES Combine Application (CAF) does not print with signature page(s).

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new manual textApplication Registration

  • revised manual textIL444-2378B must be accepted as a valid application to register if:
    • The customer submits a version that does not have the updated (Yes) or (No) option; and/or
    • It only contains a name, address and signature and other sections are incomplete. If received with just a name, address and signature, register the application for Cash, Medical and SNAP (see PM 02-04-04 ,  WAG 02-04-04); or
    • The customer submits and only checks one box. For example SNAP, but does not check a box for Medical and Cash, the application must be registered for all programs; or
    • If medical is the only program selection, the application is registered for medical benefits only. This includes applications marked with a (Yes) or (No) response to a program request to indicate whether a person is applying for the benefit. This may be a hospital application, an application for long-term care, a short spenddown application, or a QMB or SLIB application or an MSP application. If additional information is needed, send a Verification Checklist (IL444-0267) to the customer requesting the information needed to process the medical only application. If the customer does not respond or there is an inadequate response, the application is denied; or
    • It is submitted without a program choice, but other sections are completed and there is a name, address and signature, register the application for all programs.
  • revised manual textDo not return the application to the customer simply because a program selection was not made. At the interview, confirm the customer's request for benefits. Take the appropriate action to review and update the program requests. The Review/Update Program Request Wizard provides instructions to assist workers in determining if all requested programs have been registered and all individuals requesting the programs have been added to the request. Other program requests may be added, if necessary. Document all action taken, including the customer's decision to not apply for a benefit even if eligible
  • When a IL444-2378B is used as a mail-in application, the customers signature on the rights and responsibilities pages is sufficient. No additional signatures are required.
  • revised manual textIf the signature is only on the first page, the application may be registered only. A signature is still required on the rights and responsibilities pages in order to process the application.
  • revised manual textFor Family Health Plans, IL444-2378B may be processed without contact with the family. Medical Insurance Inquiry (IL444-267TPL) is not required. If the application is not complete or the family does not submit all the necessary proofs with the application, send Verification Checklist (IL444-267) requesting the needed information. See WAG 02-07-02 for further instructions.

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Both Parents in the Home

revised manual textWhen only one parent can come to the FCRC for the eligibility interview, have them sign the rights and responsibilities pages of IL444-2378B at the eligibility interview. Enter the customer's name and address on IL444-2378B. For TANF Cash, give the forms to the customer for the other parent to sign and return.