The Link Illinois Redetermination form is a crucial document used by residents of Illinois to maintain their eligibility for various assistance programs, including SNAP and TANF. This form must be completed accurately and submitted by the specified due date to ensure continued benefits without interruption. To fill out the form, please click the button below.
The Link Illinois Redetermination form serves as a crucial document for individuals and families seeking to maintain their eligibility for essential benefits, such as Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) cash assistance. This form must be completed and returned by a specified due date to ensure that benefits do not lapse. Applicants are required to provide detailed information about all household members, including their names, birth dates, and relationships, which is essential for the assessment of household composition. Additionally, the form inquires about income sources, employment status, and any changes in health insurance or address, as these factors can significantly impact benefit eligibility. Applicants must also report any recent income from various sources, such as child support or unemployment, and disclose details about housing costs, utility payments, and childcare expenses. Completing the form accurately and thoroughly is vital, as a signature is required to validate the application. Missing or incomplete information could lead to delays or denials in receiving much-needed assistance. Understanding the requirements and implications of the Link Illinois Redetermination form can empower individuals to navigate the process effectively and ensure continued support for their families.
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Here are ten common misconceptions about the Link Illinois Redetermination form, along with clarifications to help you understand the process better.
Even if nothing has changed, you still need to submit the form to continue receiving benefits.
A valid application requires a signature. Without it, your application cannot be processed.
It’s crucial to return the form by the specified due date to avoid a lapse in benefits.
All income must be reported, regardless of how it is earned. This includes tips and informal work.
It’s best to answer every question to ensure your application is complete and accurate.
Missing the due date may result in a loss of benefits, so it’s important to stay on track.
Documentation, such as pay stubs, is necessary to verify the income you report on the form.
Any changes in your household, including new members or moves, must be reported promptly.
Failure to report all income can lead to overpayments and potential penalties.
This form is also necessary for continuing TANF cash benefits and other assistance programs.
State of Illinois
Department of Human Services
2(Permanent)
Redetermination Application
Date of Notice:
Case I.D.:
Phone:
Caseload:
Write your name and address in the space below if not on form.
Your SNAP benefits will end
. To keep getting benefits on your regular availability date,
complete, sign and:
return this form in the enclosed envelope by:
(Due Date); or
bring the form with you to your scheduled appointment.
To be considered a valid application, this form must be signed.
If you receive TANF Cash, this form must be completed for your cash benefits to continue.
1. LIST ALL PERSONS LIVING WITH YOU, INCLUDING YOURSELF.
EATS WITH YOU
FULL NAME
BIRTH DATE
RELATIONSHIP
YES
NO
For additional persons, please attach a separate sheet.
2.
If you receive an HFS Medical Card, has your health insurance changed?
Yes
No
3.
Does anyone get paid for working?
No If YES, enter their name below. Attach copies of the last 4 pay
stubs if paid weekly, last 2 pay stubs if paid every other week or twice a month, and the last pay stub if paid monthly.
If self-employed, attach your income and expense statement. If someone got tips that are not on their pay stubs, tell us:
Who?
and total amount of tips received in the last 30 days. Total Tips $
List the Name of
Everybody Who is
Working
Employer
If a person works more than one job list all the employers.
Rate of Pay
Hours Worked
Weekly
How often is the person paid? Weekly, every 2 weeks, twice a month, monthly, other?
4.
Did anyone start a new job?
5.
Did anyone stop working, or did their job end?
If YES, complete the information above.
No If YES, enter name, reason, and final pay date.
IL444-4765 (R-05-14) Redetermination Application
Page 1 of 2
Printed by the Authority of the State of Illinois PO #15-0229 12,000 Copies
6. During the last 30 days did anyone receive any other income such as Child Support, Social Security, SSI, Unemployment,
VA, Worker's Compensation, contributions, or any other money?
If YES, complete the box below.
Name
Type of Income
Amount
How Often
7. Do you expect any changes in anyone's income or employment?
No If YES, what is the change?
When do you expect this change to happen?
8. Have you moved or changed your address?
No If YES, give us your new address.
9. How much is your:
Rent? $
Lot Rent? $
Mortgage? $
Enter any taxes and homeowner's insurance paid separately $
Are any of these paid by someone else?
If YES, tell us who and how much:
10. Did you receive an energy assistance payment of $21 or more this month or in any of the last 12 months from the Low
Income Home Energy Assistance Program (LIHEAP) (in Chicago paid through CEDA)?
Answering yes will not reduce your benefits. If no, are you billed separately from your rent or mortgage for heat or air
conditioning, or excess cost for heat or air conditioning?
Note: Air conditioning is a window air or central air conditioning unit.
If NO, do you pay any other utilities?
If YES, what utilities?
Does anyone help pay your utilities?
No If YES, who and what utilities?
11. Does anyone pay child support?
No If YES, who makes the payments, how much, and how often?
12. Do you pay for someone to care for a child or disabled adult so you can work, look for a job, or receive training?
No If YES, who is the care for, who provides the care, how much do you pay for the care, and how often?
13.Does anyone who is age 18 or over attend a school, other than a high school, half-time or more? If YES, who?
14. Does someone in your unit who is 60 or older or disabled have monthly medical expenses of $36 or more?
15. Has any person who is receiving Cash assistance from DHS been convicted of a felony involving drugs?
See enclosed page for important information about your application.
SIGNATURE
By signing below, I swear or affirm, under penalty of perjury, the answers on this application are true and correct to the best of my knowledge.
Signature:
Daytime or Cell Phone Number:
Date:
Page 2 of 2
Printed by the Authority of the State of Illinois
PO #15-0229 12,000 Copies
When filling out the Link Illinois Redetermination form, it is essential to approach the process with care and attention. Here is a list of things to do and avoid to ensure your application is complete and accurate.
By following these guidelines, you can help ensure that your application is processed smoothly and efficiently. Your attention to detail is vital in maintaining your benefits and ensuring that you receive the support you need.
After completing the Link Illinois Redetermination form, submit it by the due date to ensure the continuation of your benefits. You may return the form in the provided envelope or bring it to your scheduled appointment. Remember, your application must be signed to be valid.