Official Hfs 3654 Illinois Form in PDF

What is the purpose of the HFS 3654 form?

The HFS 3654 form is designed for individuals applying for long-term care assistance in Illinois. It collects additional financial information necessary to assess eligibility for medical assistance. Completing this form accurately is crucial for ensuring that applicants receive the appropriate financial support for their nursing care needs.

What information is required on the HFS 3654 form?

The form requires detailed personal information, including the applicant's name, address, and contact information. It also asks about the applicant's financial history, such as tax returns filed in the last 60 months, previous residences, and how nursing care expenses were managed prior to the application. Additionally, it inquires about any assistance received in handling financial affairs, marital status, and any inheritances received in the past five years.

How should I submit the HFS 3654 form?

The completed HFS 3654 form should be submitted to the appropriate healthcare or family services office. If the form is being submitted by a hospital or long-term care facility, it is important to include the date of admission and expected discharge date. Ensure that all sections are filled out completely and accurately, and do not forget to sign the document before submission.

What happens if I do not provide all the requested information?

Failing to provide complete and accurate information on the HFS 3654 form can lead to delays in processing your application for medical assistance. Incomplete applications may be returned for further information, which can prolong the time it takes to receive necessary support. It is advisable to carefully review the form and ensure that all questions are answered before submitting.

1. Incomplete Answers: Many applicants leave questions unanswered. Every question must be filled out completely. Missing information can delay the processing of your application.

2. Incorrect Tax Information: Some people forget to include the years they filed taxes. If you answered "Yes" to having filed a tax return, make sure to list the correct years and provide copies of those returns.

3. Missing Previous Addresses: It’s important to list the last two places you lived before your current residence or nursing home. Omitting this information can lead to complications in your application.

4. Neglecting to List Financial Assistance: If someone helps you with your finances, you must include their details. This includes family, friends, or advisors. Not providing this information can raise questions about your financial situation.

5. Failure to Provide POA Information: If you have a Power of Attorney, make sure to indicate this clearly. Specify their role and relationship to you. This is crucial for understanding who manages your financial affairs.

6. Missing Marital Status Details: Be sure to accurately state your marital status. If divorced, include the divorce decree if possible. This information is necessary for processing your application.

7. Ignoring Inheritance Questions: If you have received an inheritance in the last 60 months, you must disclose it. Provide details about the amount, date received, and the relationship to the deceased. Omitting this can lead to issues with eligibility.

When filling out the HFS 3654 Illinois form, it is crucial to adhere to specific guidelines to ensure a smooth application process. Here are seven important dos and don'ts to keep in mind:

• Do answer all questions completely and accurately. Incomplete forms can lead to delays.
• Do print your answers clearly. Handwritten responses should be legible to avoid misunderstandings.
• Do sign the document. Your signature is required for the application to be valid.
• Do provide copies of your tax returns for the last three years if you have filed them. This is essential for verifying your financial status.
• Don't leave any sections blank. If a question does not apply to you, indicate that clearly.
• Don't forget to include any necessary documentation, such as divorce decrees or proof of inheritance, as required.
• Don't submit the form without reviewing it thoroughly. Errors can lead to complications in processing your application.

By following these guidelines, you can enhance the chances of a successful and efficient review of your application. Ensure that all information is accurate and complete to avoid unnecessary delays.

The HFS 3654 form is essential for individuals applying for long-term care assistance in Illinois. Alongside this form, several other documents may be required to ensure a complete application. Below is a list of commonly used forms and documents that often accompany the HFS 3654.

• Income Tax Returns: Copies of state and federal income tax returns for the last three years are necessary if the applicant has filed taxes during that period. These documents provide a comprehensive view of the applicant's financial situation.
• Proof of Residence: Documentation showing the applicant's previous two residences is needed. This can include lease agreements, utility bills, or other official correspondence that confirms the applicant's living history.
• Self-Proving Affidavit: To expedite the probate process, utilize the essential New York Self-Proving Affidavit resources which verify the will's authenticity and signatures.
• Power of Attorney (POA) Documents: If someone is assisting the applicant with financial matters, a copy of the POA document may be required. This document outlines the authority granted to another person to act on behalf of the applicant.
• Divorce Decree: For applicants who are divorced, a copy of the divorce decree must be included. This document provides legal proof of the marital status and may contain relevant financial information.
• Insurance Policy Information: If the applicant has a nursing home insurance policy, details such as the policy number and the name of the insurance company are necessary. This information helps assess additional financial resources available to the applicant.
• Inheritance Documentation: If the applicant has received an inheritance within the last 60 months, documentation detailing the amount, date received, and the relationship to the deceased must be provided. This helps clarify the applicant's financial resources.
• Financial Planner or Attorney Statements: Any correspondence or statements from financial planners or attorneys regarding discussions about nursing home care and financial planning should be included. This provides insight into the applicant's financial planning efforts.
• Social Security Information: Details regarding Social Security benefits, including statements or award letters, may be required. This information is crucial for understanding the applicant's income sources.

Gathering these documents can streamline the application process and ensure that all necessary information is submitted. Proper documentation supports the review of the application and helps facilitate a timely decision regarding eligibility for long-term care assistance.

Misconceptions about the HFS 3654 Illinois form can lead to confusion and errors in the application process. Below are nine common misconceptions and clarifications regarding the form.

• All questions must be answered even if not applicable. Many believe they can skip questions that do not apply to their situation. However, it is crucial to provide complete information for the application to be processed efficiently.
• Only nursing home residents need to fill out this form. This form is required for anyone applying for medical assistance related to long-term care, regardless of their current living situation.
• Previous addresses are not important. Applicants often think that prior addresses are irrelevant. In fact, providing past addresses helps establish residency history, which is essential for eligibility determination.
• Tax returns are optional. Some applicants assume that submitting tax returns is not necessary. In reality, providing copies of tax returns for the last three years is mandatory if applicable.
• Financial assistance discussions are irrelevant. Individuals may believe that prior discussions with financial planners or family members about nursing care are not needed. However, this information is critical for understanding the applicant's financial planning and needs.
• Marital status does not affect the application. Many applicants overlook the importance of marital status. It is a significant factor in determining eligibility and potential benefits.
• Insurance policies are not relevant. Some may think that details about insurance policies are unimportant. However, this information can impact the assessment of financial resources and eligibility for assistance.
• Inheritances do not need to be reported. There is a misconception that inherited assets are not relevant. All inheritances received within the last 60 months must be disclosed, as they can affect financial eligibility.
• Divorce decrees are optional. Applicants often believe that including a divorce decree is not necessary. However, it is required if the applicant has been divorced, as it provides essential legal documentation of marital status.

Understanding these misconceptions can help ensure that the HFS 3654 form is completed accurately, leading to a smoother application process for long-term care assistance.