Fill a Valid Link Illinois Redetermination Template Open Editor

Fill a Valid Link Illinois Redetermination Template

The Link Illinois Redetermination form is a crucial document for individuals currently receiving SNAP benefits or TANF Cash Support from the State of Illinois Department of Human Services. This form is essential for maintaining your benefits; it must be completed, signed, and returned by a specified due date or brought to a scheduled appointment to ensure continued assistance. Remember, to keep receiving your benefits without interruption, click the button below to fill out your form today.

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For residents of Illinois relying on SNAP (Supplemental Nutrition Assistance Program) benefits, Temporary Assistance for Needy Families (TANF) Cash, or Medicaid, the Link Illinois Redetermination form becomes a crucial document for ensuring the continuity of their assistance. Issued by the State of Illinois Department of Human Services, this application requires individuals to provide an update on their current situation to determine their continued eligibility for these programs. The form is comprehensive, covering areas like household composition, income changes, employment status, and housing costs, among others. It prompts for detailed information, including any income from jobs, changes in health insurance, and expected changes in income or employment. Additionally, it addresses questions about child support, utility payments, and whether anyone in the household is attending school or has significant medical expenses. The application underscores the importance of providing accurate and complete information by reminding applicants that it must be signed to be considered valid, emphasizing the legal commitment to truthful reporting under penalty of perjury. To avoid interruption in benefits, recipients are advised to return the completed and signed form by a specified due date, either by mail in the provided envelope or by bringing it to a scheduled appointment. The form serves not only as a means to reevaluate eligibility for benefits but also as a tool for individuals to update their personal information, ensuring they receive the appropriate level of assistance tailored to their current needs.

 

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?

Yes

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?

Yes

No

5.

Did anyone stop working, or did their job end?

If YES, complete the information above.

Yes

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?

Yes

No

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?

Yes

No If YES, what is the change?

When do you expect this change to happen?

8. Have you moved or changed your address?

Yes

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?

Yes

No

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)?

Yes

No

 

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?

Yes

No

 

Note: Air conditioning is a window air or central air conditioning unit.

If NO, do you pay any other utilities?

Yes

No

If YES, what utilities?

Does anyone help pay your utilities?

Yes

No If YES, who and what utilities?

11. Does anyone pay child support?

Yes

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?

Yes

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?

Yes

No

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.

Yes

Yes

No

No

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:

 

 

 

 

 

 

 

IL444-4765 (R-05-14) Redetermination Application

 

 

Page 2 of 2

 

Printed by the Authority of the State of Illinois

PO #15-0229 12,000 Copies

 

 

 

 

 

 

 

Form Details

Fact Name Detail
Form Purpose This form is used for the redetermination of eligibility for SNAP benefits in Illinois.
Signature Requirement The form must be signed for the application to be considered valid.
Additional Documentation for Workers Applicants must attach pay stubs or income statements if they or someone in their household is employed.
Governing Law The form is governed by the rules and regulations of the State of Illinois Department of Human Services.

Filling out the Link Illinois Redetermination form is a necessary step to ensure that your SNAP benefits continue without interruption. This form is also required for the continuation of TANF Cash benefits if applicable. It's important to complete the form accurately and submit it by the due date provided in your notice. Here are the steps to follow for a complete application:

  1. Locate the date of notice, case I.D., phone number, and caseload information at the top of the form.
  2. Write your name and address in the designated space, if it's not already provided on the form.
  3. For question 1, list all persons living with you, including yourself. Specify if they eat with you, and provide their full name, birth date, and relationship to you. Attach a separate sheet if needed for additional persons.
  4. Answer "Yes" or "No" to whether your health insurance has changed if you receive an HFS Medical Card.
  5. If anyone gets paid for working, mark "Yes" and enter their name(s). Attach the required pay stubs or an income and expense statement for self-employed individuals. Also, report any tips not included on pay stubs.
  6. Indicate whether anyone started or stopped working, providing names and relevant details as required.
  7. Answer questions about any other income received in the last 30 days, including the type, amount, and frequency.
  8. Respond to the query about expected changes in anyone's income or employment.
  9. Update your address if you have moved or changed your residence.
  10. Fill in your housing expenses, including rent or mortgage, taxes, and whether any of these are paid by someone else.
  11. Answer questions related to energy assistance payments, utilities, and any help received for utility payments.
  12. If anyone pays child support, provide the payer's details, amount, and frequency.
  13. Disclose if you pay for child or disabled adult care to work, look for a job, or receive training, including details of the care provider and costs.
  14. Indicate if anyone aged 18 or over is attending school half-time or more, and if someone 60 or older or disabled has monthly medical expenses of $36 or more.
  15. Answer whether any person receiving Cash assistance from DHS has been convicted of a felony involving drugs.
  16. Sign the form, providing a contact number and date. Remember, this form must be signed to be considered valid.

After you've completed and signed the form, ensure it is returned by the due date specified in your notice. You can either mail it using the enclosed envelope or bring it to your scheduled appointment. Submitting this form on time is crucial to maintaining your benefits without interruption.

  1. What is the Link Illinois Redetermination form?

    The Link Illinois Redetermination form is an official document used by the State of Illinois Department of Human Services. It's a form that persons receiving SNAP (Supplemental Nutrition Assistance Program) benefits, TANF (Temporary Assistance for Needy Families) Cash, or other types of public assistance must fill out periodically to confirm their continued eligibility for these programs. It helps the department assess whether the financial situation of an assistance recipient has changed.

  2. Why do I need to complete the Link Illinois Redetermination form?

    You need to complete this form to avoid a disruption in your benefits. It’s a way to confirm that you still meet the requirements for the assistance you're receiving. If you are a recipient of SNAP, TANF Cash, or have an HFS Medical Card, filling out this form accurately ensures that your benefits continue without interruption on your regular availability date. Failure to return the completed form by the due date could result in the termination of your benefits.

  3. When is the Redetermination form due?

    The form comes with a "Due Date" clearly indicated. To ensure your benefits continue seamlessly, you must either return this form in the enclosed envelope by the due date or bring it with you to your scheduled appointment before that date.

  4. What should I do if my health insurance has changed?

    If your health insurance has changed and you have an HFS Medical Card, indicate this change on the form by selecting "Yes" to the relevant question and providing the necessary details about your new health insurance plan.

  5. How do I report income from employment?

    If anyone in your household gets paid for working, you must say "Yes" to the question about income and attach proof of income. This can include the last 4 pay stubs for weekly payments, the last 2 for biweekly or semi-monthly payments, or the last pay stub for monthly payments. For self-employed individuals, an income and expense statement is required. Don’t forget to report any tips not included in pay stubs.

  6. How do I report a new job or an employment termination?

    If anyone in your household has started a new job or stopped working, select "Yes" to the corresponding questions and fill out the necessary details such as the name, reason for leaving (if applicable), and the final pay date or start date of the new job.

  7. What should I do if I have moved or changed my address?

    If you've moved or changed your address, indicate "Yes" to the question about address changes and provide your new address on the form. This ensures that all correspondence related to your benefits reaches you without delay.

  8. How do I report changes in my utility payments or energy assistance received?

    Report any changes in utility payments or if someone else helps pay your utilities by answering "Yes" to the questions about utilities and detailing which utilities are affected and who is providing the assistance. If you received an energy assistance payment from the LIHEAP or similar programs, mention this as it won’t reduce your benefits but may affect your eligibility calculations.

  9. What signatures are needed on the Redetermination form?

    The form must be signed to be considered a valid application. By signing the form, you are affirming, under the penalty of perjury, that the information provided is true and correct to the best of your knowledge. Ensure that you include your daytime or cell phone number and the date when you sign the form.

Common mistakes

Filling out the Link Illinois Redetermination form is a crucial step in ensuring continued assistance from the Department of Human Services. Yet, many tend to overlook certain areas, leading to potential delays or denial of benefits. Paying attention to common mistakes can help streamline the process.

  1. Failing to list all individuals living in the household, which includes everyone who resides at the address, regardless of their financial relationship or contribution to household expenses. This information is critical in determining the amount of assistance for which one is eligible.

  2. Not updating health insurance information if one possesses an HFS Medical Card. Any changes to health insurance can affect eligibility or benefit levels, so it's important to report accurately.

  3. Omitting employment details, including failing to attach required pay stubs or accurately report income from self-employment or tips. This oversight could result in an incorrect calculation of benefits.

  4. Overlooking recent employment changes, such as starting a new job or termination of employment. These changes can significantly impact the eligibility and amount of benefits.

  5. Not accurately reporting other sources of income, like Child Support, Social Security, or Unemployment. Any external income must be disclosed to correctly determine benefit levels.

  6. Forgetting to indicate expected changes in income or employment. Anticipated changes can affect future eligibility and benefits.

  7. Address changes not being reported. It's essential to provide up-to-date contact information for receiving important notifications regarding benefit status.

  8. Incorrectly reporting rent, mortgage, or utility payments, or not disclosing if these expenses are shared with or paid by another party. This information helps assess the household's financial needs accurately.

  9. Skip mentioning if someone in the household pays child support or has child or disabled adult care expenses. Such expenses can affect the calculation of SNAP benefits.

Although completing government forms can be daunting, taking the time to carefully review and accurately fill out the Link Illinois Redetermination form is essential. It’s also important to remember that seeking assistance or clarification when unsure about certain sections can prevent delays or errors in benefit determination. Keeping these common pitfalls in mind can help ensure a smoother application process and aid in the continued receipt of necessary benefits.

Documents used along the form

Completing the Link Illinois Redetermination form is an important step to ensure continuous assistance from the State of Illinois. However, to provide a comprehensive overview and streamline the application process, several supplementary documents and forms are often required. These not only facilitate a smoother review but also help in maintaining an updated and accurate account of the applicant’s situation.

  • Income Verification Documents: These include recent pay stubs, income and expense statements for the self-employed, and documentation of any other income sources such as Social Security, Unemployment benefits, or pension receipts. They serve to confirm the income details provided in the redetermination application.
  • Expense Verification Documents: Receipts or statements related to rent, mortgage, utilities, child care, or medical expenses are crucial. They help in determining the applicant's eligibility based on their current financial obligations.
  • Proof of Household Composition: Documents like birth certificates, marriage certificates, or school records are often required to verify the household size and composition listed in the application.
  • Proof of Residency: Updated documents demonstrating residency within the state, such as utility bills, rent receipts, or a lease agreement, are necessary to ensure applicants meet the geographical criteria for the benefits.
  • Health Insurance Documentation: Copies of health insurance cards, Medicare documentation, or other health coverage proofs are required if there are changes in health insurance information, as indicated in the redetermination form.
  • Child Support Documentation: For applicants who either receive or pay child support, official documentation or court orders reflecting the amount and frequency of payments can influence the benefits calculation.
  • Employment and Training Documents: For those who have recently started or stopped a job, are seeking employment, or are undergoing training, documents such as job offer letters, termination notices, or enrollment in training programs can provide necessary context regarding changes in employment status.

Understanding and gathering these documents upfront can significantly ease the process of applying for or renewing assistance through the Link Illinois Redetermination form. Each document plays a strategic role in painting a comprehensive picture of the applicant's current living and financial situation. Being well-prepared with these documents ensures that the application review can be conducted efficiently and accurately, leading to a faster determination of eligibility.

Similar forms

The Link Illinois Redetermination form is similar to other forms used within the social services system, especially those related to benefits and assistance programs. These documents share common features in terms of structure, required information, and overall purpose. Each form serves as a tool to assess eligibility for benefits, update personal information, or report changes that could affect benefit status. Below are examples of forms similar to the Link Illinois Redetermination form and explanations of their similarities:

The Supplemental Nutrition Assistance Program (SNAP) Application Form:

  • Collects detailed personal information, including household composition, income sources, and employment status, akin to the Link Illinois Redetermination form.
  • Requests verification of income, such as pay stubs or income statements for the self-employed, to determine eligibility and benefit levels.
  • Includes sections on other types of income and expenses related to housing and utilities, mirroring the comprehensive financial overview required by the Redetermination form.

The Temporary Assistance for Needy Families (TANF) Application Form:

  • Features sections on household members, their relationships to the applicant, and their financial contributions, emphasizing the need to understand the household's economic situation.
  • Asks about any changes in employment or income, as well as expected changes, similar to the forward-looking inquiries found in the Redetermination form.
  • Requires applicants to disclose information on childcare expenses, support payments, and any educational pursuits of household members, ensuring that benefits reflect current needs and circumstances.

The Medical Assistance (Medicaid) Application Form:

  • Probes into household composition and income, similar to the Redetermination form, to establish financial eligibility for medical assistance.
  • Inquires about health insurance coverage and any changes to it, reflecting the Redetermination form’s attention to changes in circumstances that could affect benefit eligibility.
  • Asks applicants to report on any disabilities, medical expenses, or regular treatments, which can influence the type of assistance provided, paralleling the Redetermination form’s section on medical needs for those over 60 or disabled.

Dos and Don'ts

When you are preparing to fill out the Link Illinois Redetermination form for SNAP benefits, it’s important that you carefully complete each section to ensure your eligibility and benefits continue without interruption. Below is a compilation of advisable actions and practices to avoid during this critical process.

Do:
  • Verify your personal information: Ensure your name, address, and case ID are accurate on the form. If any details are missing or incorrect, correct them before submitting.
  • Include all household members: List everyone living with you, even if they are not directly related to you or receiving benefits, as their income and resources could affect your eligibility.
  • Report all income sources accurately: Include every type of income received by anyone in the household, attaching pay stubs or income statements as required. This includes employment, self-employment, tips that are not part of regular paychecks, and any other income.
  • Update any changes in employment or income: Clearly indicate any recent or anticipated changes in jobs or income levels for any household member, as this can affect your benefit amount.
  • Disclose housing and utility expenses: Accurately report your rent or mortgage, taxes, insurance, and utility payments. Also, mention any energy assistance received, as it may impact your eligibility or benefit level.
  • Sign the application: Remember, the form is only considered valid if it is signed. Ensure you sign the form before submitting it to avoid delays in your redetermination process.
  • Submit before the deadline: To prevent a lapse in benefits, mail or bring the completed form to the appropriate office by the due date provided.
  • Report changes in household composition: If someone moves in or out, or if there is a birth or death in the family, update this information promptly.
  • Include additional necessary documentation: If you pay for childcare or have medical expenses over a certain amount for elderly or disabled household members, include documentation for these expenses.
Don't:
  • Omit household members: Failing to list someone who lives with you and shares meals can lead to inaccuracies in your eligibility assessment and potential overpayment or underpayment.
  • Underreport income: All income, including occasional or irregular earnings, must be reported to ensure your benefits are calculated correctly.
  • Ignore changes in circumstances: Not reporting changes in income, employment, housing, or household composition in a timely manner can result in receiving incorrect benefit amounts.
  • Forget to sign the form: An unsigned form is considered incomplete and will delay the processing of your redetermination.
  • Misreport expenses: Incorrectly reporting your rent, mortgage, utilities, or childcare expenses can affect the benefits you are eligible to receive.
  • Use unofficial forms: Always ensure you are filling out the latest version of the official redetermination form provided by the Department of Human Services.
  • Seal required attachments loosely: Make sure all required documents are securely attached to your application to prevent loss during processing.
  • Miss the application deadline: Submitting the form after the due date can result in the termination or interruption of your benefits.
  • Provide inaccurate contact information: If your phone number or address changes, update your application immediately to ensure you receive all communication regarding your benefits.

Misconceptions

Understanding the Link Illinois Redetermination form is crucial for residents in need of continued assistance from state programs like SNAP and TANF. However, misconceptions about the process can create unnecessary obstacles. Here are five common misunderstandings and clarifications to help ensure smooth and accurate submissions:

  • Completing the form is optional if benefits are currently received.

    This is incorrect. To ensure ongoing assistance without interruption, recipients must complete and return the redetermination form by the specified due date or bring it to their scheduled appointment. This process is essential for assessing current needs and eligibility.

  • Only income from employment needs to be reported.

    Another common misunderstanding is that the form only requires disclosure of income from employment. However, all sources of income, including Child Support, Social Security, SSI, Unemployment, VA, Worker's Compensation, and any other contributions or money received, must be reported to accurately determine eligibility.

  • Signature is not mandatory if submitting in person.

    Whether the form is mailed or submitted in person, a signature is mandatory to validate the application. The importance of signing the form cannot be overstated, as it serves as an affirmation under penalty of perjury that the information provided is accurate and true.

  • Changes in income or employment status can be updated later.

    Some believe that changes in income or employment status can be communicated at a later time. However, anticipating and reporting any expected changes in income or employment on the redetermination form is crucial for maintaining benefit accuracy and avoiding overpayments or underpayments.

  • Assistance and benefits are calculated solely based on income.

    While income is a significant factor in determining eligibility and benefit levels, other factors such as household size, rent or mortgage, childcare expenses, medical expenses (for those who are eligible), and whether someone pays or receives child support are also considered. Understanding the comprehensive nature of these assessments is important for accurately completing the form.

Dispelling these misconceptions provides a clearer path for individuals and families seeking to maintain their benefits, ensuring they receive the support they need in a timely and efficient manner.

Key takeaways

Filling out the Link Illinois Redetermination form is a critical process for residents of Illinois seeking to ensure continuity in their SNAP and potentially other benefits. The stakes are high, as any mishaps in this process could lead to a temporary or permanent cessation of much-needed aid. To navigate this process smoothly, consider these key takeaways:

  • Timeliness is crucial: To avoid any interruption in benefits, it's imperative to complete, sign, and return the form by the due date provided in the notice or to bring the form to a scheduled appointment on time. Late submissions could result in a lapse in benefits.
  • Accuracy in reporting: Ensure all individuals living in the household are listed, along with any income changes, job starts or stops, and other income received in the last 30 days, such as Child Support, SSI, or Unemployment. Accuracy in this section is vital for the correct assessment of benefits eligibility and amount.
  • Documentation is key: If anyone in the household is employed, attaching copies of pay stubs or, for the self-employed, an income and expense statement is required. Additionally, reporting any changes in health insurance for those with an HFS Medical Card is necessary.
  • Up-to-date Information: Any changes in address, household composition, or significant changes expected in income or employment should be reported. This information helps ensure that benefits are calculated correctly and that all correspondence reaches the recipient.
  • Detailed Expenses Reporting: Accurately reporting monthly rent, mortgage, any utilities paid, child support payments, or care expenses for a dependent is crucial. For households with members over 60 or disabled, documenting monthly medical expenses can affect benefit calculations.

Comprehensively and accurately completing the Link Illinois Redetermination form is not just a bureaucratic hurdle; it's a vital step in maintaining essential lifelines for individuals and families in need. The dedication to detail can significantly impact the well-being of those dependent on these benefits.

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