File an EBT Theft Claim

Instructions (pdf)

RECIPIENT INFORMATION (Required)

Last Name:

First Name:

Middle Initial:

Full Link card or IDHS Case Number:

Address:

City, State, ZIP:

Phone:

Email:

INCIDENT INFORMATION (Required)

What is Electronic Theft?

Skimming - the use of electronic equipment to take your benefits whithout your knowledge.
Scamming is falsely convincing you to give your Link card/PIN and/or personal information to someone else who stole your benefits without having the physical Link card.

I am a victim of an electronic theft:

I had my Illinois Link card with me at all times:

I used my Illinois Link Card on (Date):

I used my Illinois Link Card at (location):

Have you replaced your Link Card that was used in the theft transaction:
* Note that IDHS policy is that a compromised Link card that has been used in a theft transaction MUST be replaced. You may get a replacement card at your local FCRC, or we will be mailing a new Link card to your address on file.

PLEASE LIST THEFT TRANSACTION DETAILS BELOW (Required)

Transaction Benefit Type	Date of Transaction	Amount of Transaction	Location where transaction occurred
Trx Type 1:	Trx Date 1:	Trx Amount 1:	Trx Location 1:
Type 2:	Date 2:	Amount 2:	Location 2:
Type 3:	Date 3:	Amount 3:	Location 3:
Type 4:	Date 4:	Amount 4:	Location 4:
Type 5:	Date 5:	Amount 5:	Location 5:
Type 6:	Date 6:	Amount 6:	Location 6:
Type 7:	Date 7:	Amount 7:	Location 7:
Type 8:	Date 8:	Amount 8:	Location 8:
Type 9:	Date 9:	Amount 9:	Location 9:
Type 10:	Date 10:	Amount 10:	Location 10:

ADDITIONAL INFORMATION (Optional)

You may report additional information in this section. Additional information is not required but may be helpful in processing your claim.

Additional information:

If you were instructed to call a number or go to a website, please provide that number and website information below.

If a text message, number you were instructed to call:

Website you were instructed to visit:

YOUR SIGNATURE AND DECLARATION OF TRUTH ARE REQUIRED TO PROCESS THIS FORM

I attest that the information I have stated and provided in this form are true and accurate. By signing below, I declare under penalty of perjury under the laws of the United States of America and the State of Illinois that the information I have given on this form is true, correct and complete to the best of my knowledge. I understand that if I knowingly give wrong information or leave out information that I know to be true and I receive replacement benefits that I am not eligible for, I will be responsible for repayment, I can be disqualified from receiving future benefits, I can be fined and I can be charged with a crime.

I have read, understood and accept the penalty statement above.