PM 22-02-02-a.
NOTE: Original signatures are required on all forms. Never send copies of any of these signed forms to DHS Expenditure Control Unit.
NOTE: Action cannot be taken until 10 postal workdays after the benefit's mailing date.
NOTE: The amount in Item 80 must agree with the amount shown in Item 38.
Illinois Department of Human ServicesJB Pritzker, Governor · Dulce M. Quintero, Secretary Designate
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