Official Link Illinois Redetermination Form in PDF Open Editor

Official Link Illinois Redetermination Form in PDF

The Link Illinois Redetermination form is a crucial document for individuals and families receiving benefits through the State of Illinois Department of Human Services. This form helps ensure that your Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefits continue without interruption. Completing this form accurately and submitting it on time is essential for maintaining your access to these vital resources.

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The Link Illinois Redetermination form plays a crucial role in ensuring that individuals and families continue to receive essential benefits such as Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) cash assistance. This form is not just a bureaucratic requirement; it serves as a lifeline for many who rely on these benefits to meet their daily needs. When completing the form, applicants must provide comprehensive information about their household, including the names and relationships of all individuals living with them, as well as their employment status and income sources. Changes in health insurance, job status, and any additional income must also be reported to maintain eligibility. The form requires signatures to validate the information provided, underscoring the importance of accuracy and honesty in the application process. Additionally, applicants need to disclose their housing costs and any assistance they receive for utilities, ensuring that all factors influencing their financial situation are considered. By understanding the components of the Link Illinois Redetermination form, individuals can navigate the process more effectively, ensuring they remain connected to the support they need.

Frequently Asked Questions

What is the Link Illinois Redetermination form?

The Link Illinois Redetermination form is a document used by individuals receiving SNAP (Supplemental Nutrition Assistance Program) benefits and TANF (Temporary Assistance for Needy Families) cash assistance in Illinois. It helps the Department of Human Services assess your ongoing eligibility for these benefits. Completing this form is crucial to ensure that your benefits continue without interruption.

Why do I need to complete the Redetermination form?

You need to complete the Redetermination form to verify your current circumstances and to confirm that you still qualify for assistance. This form collects information about your household, income, and any changes in your living situation. If you do not submit it by the due date, your benefits may be discontinued.

How do I submit the Redetermination form?

You can submit the form in two ways. First, you can complete and sign the form, then return it in the enclosed envelope by the specified due date. Alternatively, you can bring the completed form to your scheduled appointment with the Department of Human Services. Make sure it is signed, as an unsigned form will not be considered valid.

What happens if I miss the due date for submitting the form?

If you miss the due date, your SNAP benefits may end, and you may need to reapply for assistance. It's essential to submit the form on time to avoid any gaps in your benefits. If you find yourself in this situation, contact your local DHS office as soon as possible to discuss your options.

What information do I need to provide on the form?

The form requires various details, including names and birthdates of all household members, income information, changes in employment, and any other financial assistance received. You may also need to attach supporting documents, such as pay stubs or income statements, to validate the information provided.

What if my situation changes after I submit the form?

If your situation changes after you submit the Redetermination form, you must inform the Department of Human Services immediately. This includes changes in income, employment status, household composition, or address. Keeping them updated ensures that your benefits accurately reflect your current circumstances.

Form Specifications

Fact Name Details
Governing Law The Link Illinois Redetermination form is governed by the Illinois Department of Human Services regulations.
Purpose This form is used to determine ongoing eligibility for SNAP and TANF benefits.
Submission Deadline The completed form must be returned by the specified due date to avoid interruption of benefits.
Signature Requirement A valid application requires the applicant's signature to be considered complete.
Income Reporting Applicants must report all sources of income, including employment and other benefits received in the last 30 days.
Changes in Circumstances Applicants must disclose any expected changes in income or employment that may affect eligibility.
Utility Assistance Questions regarding energy assistance payments and utility costs are included to assess additional needs.

Common mistakes

  1. Missing Signature: Failing to sign the form is a common mistake. Without a signature, the application cannot be processed.

  2. Incomplete Information: Leaving out details about household members can lead to delays. Ensure that all individuals living with you are listed, including their full names and relationships.

  3. Incorrect Income Reporting: Not accurately reporting income can jeopardize benefits. Include all sources of income and attach necessary documentation, such as pay stubs.

  4. Neglecting Changes in Employment: Failing to report new jobs or job losses is crucial. This information affects eligibility and benefit amounts.

  5. Ignoring Additional Income: Overlooking other income sources, like child support or social security, can lead to incomplete applications. All income must be reported.

  6. Address Changes: Not updating your address can result in missed communications. If you have moved, provide your new address promptly.

  7. Utility Payments: Failing to disclose utility payments or assistance can impact your benefits. Be sure to report any help you receive or pay for utilities.

  8. Child Care Costs: Not mentioning expenses for child or adult care can lead to a loss of potential deductions. Report these costs accurately.

  9. Missing Deadlines: Not submitting the form by the due date can result in a loss of benefits. Pay attention to the deadline and ensure timely submission.

Form Preview

 

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

 

 

 

 

 

 

 

Dos and Don'ts

When filling out the Link Illinois Redetermination form, it is important to follow certain guidelines to ensure your application is processed smoothly. Here are ten things to keep in mind:

  • Do fill out the form completely. Missing information can delay your benefits.
  • Don't forget to sign the form. An unsigned application is not valid.
  • Do provide accurate names and addresses of everyone living with you.
  • Don't leave out any sources of income. Be honest about all earnings.
  • Do attach required documentation, like pay stubs or income statements.
  • Don't ignore the due date. Submit your form on time to avoid losing benefits.
  • Do indicate any changes in your household, such as new jobs or moves.
  • Don't forget to include information about child support or other financial assistance.
  • Do check your contact information for accuracy, including your phone number.
  • Don't hesitate to ask for help if you have questions about the form.

Following these tips can help ensure that your application is complete and that you maintain your benefits without interruption.

Documents used along the form

The Link Illinois Redetermination form is a crucial document for individuals seeking to maintain their SNAP and TANF benefits. However, there are several other forms and documents that may accompany this application to ensure a smooth and complete process. Understanding these documents can help applicants prepare adequately and avoid delays in their benefits.

  • Verification of Income Form: This document provides detailed information about an applicant's income sources. It may require proof such as pay stubs or bank statements to verify the reported income.
  • Employment Verification Form: Often required by the Department of Human Services, this form confirms an applicant's employment status, including job title, hours worked, and salary. Employers typically fill this out directly.
  • Housing Information Form: This form collects information about the applicant's living situation, including rent or mortgage payments. It helps determine eligibility based on housing costs.
  • Mechanics Lien California Form: This document is essential for securing payment for work performed on a property and can help contractors and suppliers protect their rights. For more information on filling out the necessary form, visit California Templates.
  • Medical Expense Verification Form: For those claiming medical expenses, this form lists all relevant costs. It may include prescriptions, doctor visits, and other healthcare-related expenses that could affect benefit calculations.
  • Child Care Expense Form: Applicants who pay for child care to work or attend school must provide this form. It details the costs associated with child care services, which can influence benefit eligibility.
  • Social Security Number Verification: This document verifies the Social Security numbers of all household members. It is essential for the application process and helps prevent fraud.
  • Change of Address Form: If an applicant has moved, this form must be submitted to update their address in the system. It ensures that all communications and benefits are directed to the correct location.

By gathering these documents along with the Link Illinois Redetermination form, applicants can streamline the process and enhance their chances of receiving uninterrupted benefits. Proper preparation can make a significant difference in ensuring that all necessary information is provided and that eligibility is maintained.

Misconceptions

Here are four common misconceptions about the Link Illinois Redetermination form:

  • Misconception 1: The form is optional for continuing benefits.
  • This is incorrect. Completing and submitting the form is mandatory to maintain your SNAP or TANF benefits. If you do not submit it by the due date, your benefits will end.

  • Misconception 2: Only the person receiving benefits needs to complete the form.
  • All individuals living in the household must be listed on the form, including their income and employment status. This information is necessary for an accurate assessment of your benefits.

  • Misconception 3: You can submit the form after the due date without consequences.
  • Misconception 4: Changes in income or employment do not need to be reported until the next redetermination.
  • This is false. You must report any changes in income or employment as they occur. Failure to do so can affect your eligibility and benefit amount.