

(Most current IDHS Logo-2022-Float Left)
(Most current IDHFS Logo-2022-If MR concerns HFS information-Float Right)
XX/XX/XXXX
Summary (Heading 2)
Topics (Heading 2)
Sub Topics (Heading 3)
MANUAL REVISIONS (Heading 2)
PM Revisions (linked to the actual PM) WAG Revisions (linked to the actual WAG)- 1 Column for the PMs and 1 Column for the WAGs
[signed copy on file]
Name of Current Secretary (No Heading, bolded)
Current Title of Secretary (could be Secretary, Acting Secretary, Secretary-Designate), Illinois Department of Human Services
Name of Current Director (IDHFS) (No Heading, bolded)
Director, Illinois Department of Healthcare and Family Services
Forms referenced (Heading 2)
(Listed with bullet points, but not linked to the actual form)