Enter the month, day, and year of birth as numbers. Enter the day and month as 2-digit numbers. Enter the year as a 4-digit number.
Example: For a birthdate of September 7, 1999, enter: 01 07 1999
If only the month and year are known, enter the day of birth as the first day of the month. For an RPY, RPN, or TEMP payee, if the information is unavailable, enter 2 dashes each for the month and day and 4 dashes for the year.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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