The IL444 3455E form, created by the State of Illinois Department of Human Services - Bureau of Child Care and Development, is designed to assist income-eligible families in securing financial aid for child care services while engaging in employment, education, or job-related training. This form serves as a redetermination application to ensure continued support for child care expenses, requiring detailed information about employment, school attendance, and household composition. To maintain your child care assistance without interruption, complete and submit your IL444 3455E Redetermination form promptly. Click the button below to begin the process.
In the realm of family support services offered by the State of Illinois, the IL444 3455E form serves as a critical document for thousands of families seeking assistance with child care. This form, employed by the Department of Human Services - Bureau of Child Care and Development, facilitates the process of Child Care Redetermination. It enables income-eligible families to apply for financial support to cover child care expenses while they engage in work, education, or training activities. The importance of completing the form correctly cannot be overstated, as it requires detailed information regarding employment, schooling, and family composition. In particular, it underscores the necessity to report any changes in employment status, provide comprehensive family information including children's immigration status (while reassuring applicants of their confidentiality and non-discrimination), and attach substantiating documents such as pay stubs or school schedules. The form also provides guidance on how to reach out to local Child Care Resource and Referral (CCR&R) agencies for assistance in filling out the form, ensuring that all families have the support they need to navigate the process successfully. Correct and timely submission of this form not only influences the eligibility and continuation of child care support but also illustrates the state's commitment to reducing barriers for families in accessing essential child care services. By delineating these procedures and requirements, the IL444 3455E form plays a pivotal role in sustaining the well-being of Illinois families, aiding parents and guardians in their efforts to balance work and family responsibilities effectively.
State of Illinois
Department of Human Services - Bureau of Child Care and Development
CHILD CARE REDETERMINATION
Client:
Parent/Guardian Name:
Date of Notice:
KEEP FOR YOUR RECORDS
The State of Illinois helps income eligible families pay for their child care services while they work or go to school, training and other work-related activities. To apply please read the following pages carefully and then submit your completed Redetermination to your local Child Care Resource and Referral (CCR&R) or child care center/home if they have a contract with IDHS to provide child care assistance. If you have any questions about your eligibility or if you need help completing this form, call your local CCR&R. To find your local CCR&R go to http://www.inccrra.org/find-your-local-ccrr-other or call 1-877-202-4453 (toll-free).
Please be sure that all of the information is complete before sending in your Redetermination:
*The Redetermination is filled out clearly in blue or black ink.
*All questions on the Redetermination are complete. If the section or question does not apply, write "n/a in the box to show that the question was not missed.
*This information is for your current job/education activity. You will inform the CCR&R or Site provider if any information changes in the future.
*The parent/guardian's name is listed at the top of each page of the Redetermination.
*Both you and the other parent/adult have signed the Redetermination (page 12).
*All social security numbers are listed clearly or "n/a" is listed in the box. Social security numbers are not required for parents or children but they are used to gather information to help determine your eligibility for child care assistance. All information is confidential and will not be shared with anyone else.
*All Family Information is complete in Section 3 (page 7) including information about your children's immigration status. Children can get assistance regardless of their immigration status, but IDHS is required to ask for this information. This information will not be shared with anyone. Your child's alien registration number must be listed if they have one.
*All persons living in your household are listed in Section 3 (page 7).
*If working, at least one of the following is attached to verify your employment and the employment of everyone listed in your family size that is 19 years of age or older:
**Copies of your last (2) paycheck stubs, or if you have not been working long enough to get two paychecks:
--A letter from your employer or an employment verification form listing the following:
■The date you started working.
■The amount of money you are paid.
■Your typical work schedule, including the total number of hours you work per week.
■Your employer's address and phone number.
■Your employer's signature, or
**Verification of your self-employment. This can include:
--A copy of your most recent Federal income tax return (IRS 1040) and all schedules and attachments.
--A copy of your quarterly estimated taxes.
--A listing of all business income and expenses for the last 30 days. This can be reported on your own form or on a Self-Employment form which can be downloaded at http://www.dhs.state.il.us/OneNetLibrary/27897 /documents/Forms/IL444-2790.pdf or requested from your local CCR&R. When reporting income and expenses, receipts, invoices, or other documentation must be attached to verify all information.
*If in school, ALL of the following are attached:
**Copies of your official school schedule.
**Copies of your most recent report card showing your cumulative grade point average (GPA).
*You have made a copy of your Redetermination for your records. You understand if you send original check stubs or other documents that they will not be returned.
*All jobs and income information for BOTH parents have been reported on pages 3 through 6 and documentation is attached.
* You understand that if any questions are left blank or if any attachments are missing, your redetermination form will be returned to you as incomplete. This may cause a delay in approval for Child Care Assistance Program payments.
*You also understand that all of the information you submit will be verified using State and/or local databases and the internet. If any inconsistencies are discovered, your redetermination may be delayed or your participation in the Child Care Assistance Program may be cancelled.
IL444-3455E (R-6-11)
Page # of ##
Child Care Case Number:
Caseload Code:
Return your completed Redetermination to:
YWCA Metropolitan Chicago
55 E North Ave.
Glendale Heights, IL 60139
Fax: 630-790-0722
Reason for Child Care:
Provider(s):
Your eligibility for CHILD CARE needs to be Redetermined at this time. Please complete and return this form to us at the address
listed above. If we do not receive this information within 10 business days, your child care will be CANCELED. If you are having problems filling out this form, please contact us.
IF YOU'RE EMPLOYED, ATTACH COPIES OF YOUR 2 MOST RECENT PAYSTUBS.
IF YOU'RE ATTENDING A TANF REQUIRED ACTIVITY (such as education or training), ATTACH A COPY OF YOUR CURRENT RESPONSIBILITY AND SERVICE PLAN (RSP).
IF YOU'RE ATTENDING SCHOOL BUT NOT ON TANF, ATTACH A COPY OF YOUR SCHOOL SCHEDULE AND MOST RECENT REPORT CARD. IF YOU'RE A TEEN PARENT ATTENDING HIGH SCHOOL/GED, ONLY A COPY OF YOUR SCHOOL SCHEDULE IS NEEDED.
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.
PLEASE READ THE ATTACHED INSTRUCTIONS BEFORE COMPLETING THIS FORM (P. 1).
SECTION 1 - PARENT/GUARDIAN INFORMATION
WORK INFORMATION - If you are working more than one job, you MUST tell us about all your jobs even if don't
need child care for that job. Photocopy this page and complete a separate work information and work schedule section for each job you have.
Number of jobs currently working
List a phone number where we can reach you during the day:
Current Employer/Company Name
Job Title
Address
City
State
Zip Code
Work Telephone Number
Ext.
Date you started this job:
I earn before deductions (complete one)
$
per hour OR $
per month OR $
per year
I get paid (check one)
every day
every week
Number of hours usually worked at
Number of days usually worked at this
this job each week
job each week
every two weeks
twice per month
once per month
other (please explain)
Travel time from the child care provider to work:
Do you use public transportation?
WORK SCHEDULE: If your schedule varies, provide an example of your schedule.
MON
TUES
WED
THURS
FRI
SAT
SUN
FROM
AM
PM
TO
If your schedule varies, please explain how (you may send additional schedules to show how).
If any of the information on the previous page is incorrect or has changed, Parent/Guardian Name: please complete the following section with your current work information.
New or Corrected Employer/Company Name (Copy and complete additional sheets as necessary)
New or Corrected Job Title
New or Corrected Address
New or Corrected City
New or Corrected Work Telephone Number
Updated or Corrected Pay Information (complete one)
NEW OR CORRECTED WORK SCHEDULE: If your schedule varies, provide an example of your schedule.
If your schedule varies, please explain how (you may send additional schedules to verify):
Is this a new job since your last redetermination?
Yes
No
If YES, your previous employer's name:
Date previous job ended:
SCHOOL/TRAINING/TANF-REQUIRED ACTIVITY INFORMATION
Are you currently attending school, training or a TANF-Required Activity?
No (Go to Section 2 - Other Parent/Stepparent Information P. 4)
Yes (Verify/Complete the information below.)
TYPE OF EDUCATION/TRAINING CURRENTLY ATTENDING: (Check one)
Type of Degree Being Earned (GED/High
High School or GED
Below Post - Secondary (e.g., ABE or ESL)
school diploma, trade school certificate, BA
degree)
Occupational/Vocational
2-Year College Degree
Internship
4-Year College Degree
Work Experience (TANF only)
What is the highest level of education you have completed (GED/High school
Do you already have a professional license degree, or certificate? Yes
diploma, trade school certificate, BA degree)?
If yes, what type:
School Name/Training Program Currently Attending
Telephone Number
Term Start Date
Term End Date
Travel time from the child care provider to school:
SCHOOL SCHEDULE: Please complete the following schedule
If any of the information on the previous page is incorrect or has changed, please complete the following section with your current school/training information.
NEW OR CORRECTED SCHOOL/TRAINING/TANF-REQUIRED ACTIVITY INFORMATION
Type of Degree Being Earned (GED/High school diploma, trade school certificate, BA degree)
What is the highest level of education you have completed (GED/High school diploma, trade school certificate, BA degree)?
Do you already have a professional license, degree, or certificate? Yes
Term State Date
Travel time from the child care provider to school:Do you use public transportation?
NEW OR CORRECTED SCHOOL SCHEDULE: Please complete the following schedule
SECTION 2 - OTHER PARENT/GUARDIAN/STEPPARENT INFORMATION
Is the other parent or stepparent of any of your children, step children or wards living in your home?
No (Go to Section 3 - Family Information P. 7)
Yes (Complete the information below.)
Please note: Information from various agencies' database and internet web sites will be taken into consideration.
If the information does not match it may delay your eligibility.
If the other parent or stepparent could be listed on your case for other benefits (TANF, SNAP/Food Stamps, Medical, Child Support Enforcement, Unemployment) but is no longer living with you, you may need to supply additional information to prove he/she is living somewhere else. If you cannot provide this documentation, please contact your local CCR&R or Site Administered child care provider.
OTHER PARENT/GUARDIAN/STEPPARENT INFORMATION
Other Parent/Guardian/Stepparent First Name
M.I.
Last Name
Social Security Number (Optional)
Date of Birth (include month/day/year)
Is the other parent or stepparent working?
Is the other parent or stepparent attending school or a training program?
If the other parent or stepparent is not working or in a school/training program, please explain why he/she cannot care for the children.
WORK INFORMATION - If the other parent/stepparent is working more than one job, you MUST tell us about all their jobs even if you don't need child care for that job. Photocopy this page and complete a separate work information and work schedule section for each job they have.
Number of jobs they are currently working
First Employer/Company Name
Date they started this job:
They earn (complete one):
per year)
How often are they paid (check one)
Number of hours usually worked
Number of days usually worked
at this job each week
OTHER PARENT WORK SCHEDULE: If their schedule varies, provide an example of the schedule.
If other parent/stepparents schedule varies, please explain how (you may send additional schedules to show how.)
If any information is incorrect or has changed, please complete the following section with the current work information for the other Parent/Guardian.
NEW OR CORRECTED OTHER PARENT/GUARDIAN/STEPPARENT INFORMATION
Other Parent's New or Corrected Employer/Company Name (Please copy and complete additional sheets as necessary)
New or Corrected Work Telephone
They get paid
(check one):
Do they use public transportation?
OTHER PARENT WORK SCHEDULE: If the schedule varies, provide an example of the schedule.
If their schedule varies, please explain how (you may send additional schedules to show how.)
OTHER PARENT SCHOOL/TRAINING/TANF-REQUIRED ACTIVITY INFORMATION
Is the other parent/guardian/stepparent currently attending school, training or a TANF-Required Activity?
NO (Go to Section 3 - Family Information P. 7)
YES (Complete the information below)
What is the highest level of education they have completed (GED/High school diploma, trade school certificate, BA degree)?
Do they already have a professional license, degree, or certificate?
OTHER PARENT SCHOOL SCHEDULE: Please complete the following schedule
NEW OR CORRECTED OTHER PARENT SCHOOL/TRAINING/TANF-REQUIRED ACTIVITY INFORMATION
If any of the information above is incorrect or has changed, please complete the
following section with your current school/training information.
What is the highest level of education they have completed (GED/High school
Yes No
NEW OR CORRECTED OTHER PARENT SCHOOL/TRAINING/
TANF-REQUIRED ACTIVITY INFORMATION
Travel time from the child care provider to school.
SECTION 3 - FAMILY INFORMATION
Family size includes these people LIVING IN YOUR HOME:
*
You,
Your biological or adopted children under age 21.
The biological, step or adoptive parent of any of your children must be included.
Any other person related to you by blood or law for whom you provide more than 50% of their support (if you choose to
include them and can verify their income) - for example an elderly parent or disabled person.
My family size:
If any information is no longer correct, please cross out and write in
I need child care assistance for the following children:
correct information.
FIRST NAME
LAST NAME
DATE OF
M/F
ETHNIC
U.S. CITIZEN
SOCIAL SECURITY
WARD OF
BIRTH
ORIGIN*
YES/NO**
NUMBER (Optional)
THE STATE
*For each child's Ethnic Origin, list all numbers below that apply: (Required for Federal Reporting) 1 - White 2 - Black or
African American 3 - Hispanic or Latino (Persons declaring Hispanic ethnicity should also list their race, for example, "3-1",
"3-2", "3-5") 4 - Asian 5 - American Indian or Alaskan Native 6 - Native Hawaiian or Pacific Islander
** If any of the children are not citizens, provide alien registration documentation if you have it.
List all other family members (not already listed in the Redetermination) counted in your family size:
RELATIONSHIP
TO APPLICANT
SECTION 4 - CHILD CARE ARRANGEMENT
If any of the information below has changed, please cross out the wrong information and NEATLY write in the correct information. Use an extra piece of paper or the bottom of this page, if necessary.
LIST THE CHILDREN CARED FOR BY EACH PROVIDER. If your children go to school, preschool, or Headstart during the day, list only the hours that they are with the child care provider. (This is not a Provider Change Form.)
1) Provider Name:
Child's Name
Age
TUE
THU
Relationship to Client:
Does the child attend school?
Year Round
What hours is the child in school?
Does the child care schedule vary?
If yes, please explain:
2) Provider Name:
3) Provider Name:
Filling out the IL444 3455E form is a crucial step for families in Illinois seeking assistance with child care expenses through the Department of Human Services. This form, part of the Child Care Assistance Program (CCAP), helps determine if you continue to qualify for help with child care costs. Completing it accurately ensures that you can receive the necessary support for your work or education-related child care needs. Here are step-by-step instructions to guide you through this process:
After submission, your local CCR&R will process your Redetermination. You will be notified of your eligibility status. It is essential to respond promptly to any requests for additional information to avoid delays in your child care assistance. If your circumstances change after submission, such as changes in employment, income, household size, or child care needs, notify your CCR&R immediately. Keeping your information up to date helps ensure that you receive the appropriate level of assistance.
What is the IL444 3455E form used for?
The IL444 3455E form, issued by the State of Illinois Department of Human Services - Bureau of Child Care and Development, is designed for income eligible families seeking assistance to pay for child care services. This form is crucial for the redetermination of eligibility for such assistance while the applicant is working, attending school, training, or participating in other work-related activities. It ensures families continue to receive support by reviewing their current situation and making necessary updates to their information and financial status.
How can I submit the IL444 3455E Redetermination form?
After carefully reading and completing the form, you can submit it in two ways. First, you can send your completed redetermination form to your local Child Care Resource and Referral (CCR&R) agency. Alternatively, if your child care center or home has a contract with the Illinois Department of Human Services (IDHS) to offer child care assistance, you can submit it directly to them. Ensure all sections are completed with clear information in blue or black ink, attaching any required verification documents like pay stubs or school schedules as specified in the form instructions.
What should I do if I don't have recent paystubs or if I'm self-employed?
If you haven't been working long enough to receive two paychecks or if you're self-employed, alternative documents can be submitted for employment verification. For those without recent paychecks, a letter from your employer or an employment verification form detailing start date, pay rate, work schedule, and contact information can be provided. Self-employed individuals should attach a copy of their most recent Federal income tax return (IRS 1040) along with any schedules, or a detailed listing of their business income and expenses for the last 30 days using a form available on the IDHS website or provided by their local CCR&R.
What happens if I leave some questions blank or if I forget to attach required documents?
It's critical to answer every question on the IL444 3455E form and attach all required documents for your redetermination to be processed efficiently. If any sections are left blank or necessary attachments are missing, the form will be returned to you as incomplete. This will invariably delay the approval of your application for the Child Care Assistance Program payments. To avoid such delays, double-check each section for completeness and confirm that all required attachments are included before submission.
Filling out the form with pens that aren't in blue or black ink. The requirement is clear: to use blue or black ink only. This ensures that the form is legible and photocopies well, but it's easy to miss if you're in a hurry and grab whatever pen is closest.
Leaving questions blank instead of writing "n/a" if the section doesn't apply. Many people might skip over questions that they believe don't relate to them. However, every skipped question could be seen as an oversight, potentially slowing down the review process.
Not updating personal information, such as the parent/guardian's name, at the top of each page. This step is crucial for keeping your documentation organized, especially in a situation where pages might get separated.
Forgetting to sign the Redetermination on page 12 by both parents/adults in the household. The signature is the most common oversight that can stall the process, as it's the official consent and confirmation of the information provided.
Not listing all social security numbers clearly or marking "n/a" where appropriate. This mistake can lead to incomplete applications, as social security numbers are a key piece of your identification for eligibility checks.
Leaving out information about your child's immigration status or failing to provide their alien registration number if they have one. Despite the concern around sharing this information, it's a necessary step for processing and doesn't affect eligibility.
Excluding some residents living in the household in Section 3. Every individual living in your household can influence eligibility and assistance levels, so it’s key that everyone is accounted for accurately.
Failing to attach the required employment verification documents or recent pay stubs. Inadequate proof of employment or income is one of the top reasons forms are returned as incomplete.
Neglecting to make a copy of the Redetermination for personal records before sending. While not a direct cause for application denial, not keeping records can complicate resolving issues or answering follow-up questions.
Each of these mistakes can delay the process of obtaining child care assistance, leading to unnecessary stress and potential gaps in care. Paying close attention to the details, double-checking that all required sections and documents are completed and attached, and verifying all information against the instructions provided ensures a smoother process for families in need of assistance.
Applying for or renewing child care assistance through the State of Illinois involves submitting the IL444-3455E form, but it's often just one piece of the puzzle. Several other documents are usually needed to ensure a complete and accurate application. Knowing which forms and documents to prepare can streamline the process and reduce the stress of last-minute rushes to gather information.
Completing the IL444-3455E form and gathering the necessary accompanying documents can be a time-consuming process. However, preparing these documents in advance can help ensure a smoother process. Each document plays a vital role in establishing eligibility for child care assistance, giving the Department of Human Services a complete picture of the family's needs and resources. Compliance with these requirements helps secure the support families need to work or pursue education, knowing their children are cared for.
The IL444-3050 form, known as the Application for Child Care Assistance, shares similarities with the IL444-3455E form in that both are required by the Illinois Department of Human Services (IDHS) for accessing child care benefits. They collect detailed information on employment, income, and family composition to determine eligibility for child care assistance programs.
The IL444-2790 Self-Employment Record is another form that shares a link with the IL444-3455E form, especially for parents or guardians who are self-employed. The IL444-3455E form mentions the need for providing documentation supporting self-employment income and expenses, for which the IL444-2790 form is utilized.
The Form W-2, Wage and Tax Statement, while not a state form, is inherently connected to the information required in the IL444-3455E for employment verification. The IL444-3455E requires copies of recent paycheck stubs or, in lieu of being employed long enough to receive two paychecks, other forms of employment verification that closely align with the information reported on a W-2.
The Federal IRS Form 1040, used for filing individual income tax returns, is similar to sections of the IL444-3455E that deal with reporting income. For self-employed individuals, the IL444-3455E form specifically asks for a copy of the most recent Federal income tax return, making these documents directly tied in the application process for child care assistance.
The Verification of Employment (VOE) form, though not specifically named in the IL444-3455E form, is indicated through the requirement for a letter from the employer or an employment verification form detailing employment status, income, and schedule, which aligns with the standard information a VOE provides.
School enrollment verification documents are similar to the IL444-3455E’s requirements for individuals attending school or training programs. The form asks for copies of official school schedules and recent report cards, echoing the necessity to submit comparable official documentation for educational pursuits.
The Temporary Assistance for Needy Families (TANF) Responsibility and Service Plan (RSP) is directly referenced in the IL444-3455E form for individuals engaged in TANF-required activities. This highlights the requirement for documentation of education, training, or work requirements as part of the TANF program, aligning closely with the child care assistance eligibility criteria.
The IL444-1965, Request for Cash Assistance, Medical Assistance, and Supplemental Nutrition Assistance Program (SNAP), shares a similar purpose with the IL444-3455E form by collecting detailed personal, familial, and financial information to assess eligibility for various state assistance programs, including those related to child care.
When filling out the IL444-3455E Child Care Redetermination form for the State of Illinois Department of Human Services, following certain guidelines can help ensure the process is completed smoothly and accurately. Here is a list of dos and don'ts to keep in mind:
Following these guidelines when completing the IL444-3455E form will help ensure that the process is done correctly, thereby aiding in the timely approval of your Child Care Assistance Program benefits.
Understanding the IL444 3455E form, also known as the Child Care Redetermination form for the State of Illinois Department of Human Services, is crucial for eligible families seeking assistance with child care expenses. However, several misconceptions can mislead applicants:
Addressing these misconceptions ensures that families in need of child care assistance are well-informed and can confidently navigate the application process without unnecessary barriers.
Snap Income Verification - Must be completed and returned within ten business days to avoid disruption in childcare payment assistance.
Illinois Iema 243 - Registration accommodates lasers for both private and supplier use, requiring detailed status updates.