This billing form may be used for Fee-for-Service Programs that are billed on a daily basis.Agencies that have access to the Reporting of Community Services (ROCS) software must bill via File Transfer Protocol (FTP). Different billing forms are used for fee-for-service programs that are billed on an event basis or on an hourly basis.
The following instructions will assist in completing the form. If there are questions, please contact the case manager for the individual for additional information.
Submit completed billing forms to the address below. If your agency has ROCS, do not submit paper bills.
Programmatic Vouchering Unit
DHS Office of Clinical, Administrative, and Program Support
401 North 4th Street 2nd floor
Springfield, Illinois 62765
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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