Free Link Illinois Redetermination Template

Free Link Illinois Redetermination Template

The Link Illinois Redetermination form is a crucial document used by the State of Illinois Department of Human Services to assess ongoing eligibility for SNAP benefits and, if applicable, TANF Cash assistance. It requires recipients to update their personal information, income, and household composition to ensure they continue receiving the correct aid. By accurately completing and submitting this form by the specified due date—either by mail or during a scheduled appointment—beneficiaries can avoid potential disruptions in their assistance. Ensure your benefits remain uninterrupted by filling out the form today; click the button below for more information.

Open Link Illinois Redetermination Editor

Navigating the process to maintain benefits under SNAP (Supplemental Nutrition Assistance Program) or TANF (Temporary Assistance for Needy Families) in Illinois necessitates an understanding of various forms, among which the Link Illinois Redetermination form is crucial. This form functions as a cornerstone for individuals and families to continue receiving assistance without interruption. It is issued by the State of Illinois Department of Human Services and requires recipients to provide comprehensive updates on their household situation, including income, employment changes, health insurance status, and any alterations in household composition. The form mandates the disclosure of details such as names and relationships of all household members, recent changes in earnings or jobs, and anticipated income shifts. It also inquires about living arrangements and associated expenses, addressing issues like rent, mortgage, utilities, and whether these expenses are assisted by others. Importantly, the form includes questions about receiving child support, caring for dependents to enable work or training, and significant medical expenses for older or disabled household members. Completing and signing this form, along with timely submission by the specified due date or bringing it to a scheduled appointment, ensures the continued provision of vital benefits to those in need. The process underscores the importance of accuracy and honesty, with a signature attesting to the truthfulness of the provided information under penalty of perjury. Thus, the Link Illinois Redetermination form is not just paperwork; it's a critical step in ensuring that support reaches those who rely on it, reflecting the state's commitment to aiding its residents in maintaining stability and dignity.

 

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 Properties

Fact Name Description
Form Title Link Illinois Redetermination Application
Issuing Department State of Illinois Department of Human Services
Purpose To reevaluate eligibility for continued SNAP benefits and TANF Cash assistance.
Signature Requirement Must be signed to be considered a valid application.
Additional Document Requirements Requires attachment of pay stubs for employed members, income and expense statement for self-employed.
Income Information Section Includes employment details, other income, expected changes in income or employment.
Housing Expenses Inquiry Queries on rent, mortgage, taxes, homeowner's insurance, and energy assistance payments.
Utilities and Child Support Payments Collects information on utilities paid and child support obligations.
Governing Law Administered under the Authority of the State of Illinois, as indicated on the form.

Filling out the Link Illinois Redetermination form is an important step in ensuring that you continue to receive SNAP benefits or TANF Cash assistance without any gaps. The form requires you to provide updated information about your household, income, and expenses to assess your eligibility for continued assistance. This thorough process is designed to ensure that the support provided aligns with your current needs. Let's walk through the necessary steps to accurately complete this form and discuss what happens once you submit it.

  1. Review the entire form to understand what information and documentation you will need.
  2. In the space provided, write your name and address if it isn't already on the form.
  3. List all persons living with you, including yourself, under section 1. Provide their full name, birth date, and relationship to you, alongside indicating whether they eat with you.
  4. If applicable, answer the question regarding changes in health insurance under section 2 by checking 'Yes' or 'No'.
  5. Under section 3, mark 'Yes' or 'No' to indicate if anyone receives income from work. If 'Yes', provide the required details of their employment and attach the necessary pay stubs or income statements.
  6. Answer the queries about new employment, job termination, or ending within sections 4 and 5. Supply necessary details if applicable.
  7. For section 6, report any other income received in the last 30 days such as Child Support or Social Security. Fill in the name, type of income, amount, and frequency.
  8. In section 7, divulge any expected changes in income or employment and provide the specifics of these anticipated changes.
  9. Update your address under section 8 if you have moved or changed your address by marking 'Yes' and supplying the new address.
  10. Document your housing expenses in section 9 and specify if these costs are paid for by someone else, providing details thereof.
  11. Answer questions regarding LIHEAP assistance or other utility payments in section 10 and specify who helps with these costs if applicable.
  12. If you or someone in your household pays child support, report this under section 11 with the relevant details.
  13. Detail any paid childcare or care for a disabled adult in section 12 to allow you to work, search for employment, or receive training.
  14. Confirm if any household member over 18 attends school at least half-time in section 13.
  15. Report if someone in your household over 60 or disabled has monthly medical expenses of $36 or more in section 14.
  16. Indicate whether any individual receiving Cash assistance from DHS has a felony conviction involving drugs.
  17. Sign and date the form at the signature section, after thoroughly verifying the accuracy of all information provided. Include your daytime or cell phone number.

Once completed and signed, the form must either be returned in the provided envelope by the specified due date or brought with you to your scheduled appointment. It's imperative to ensure the form is signed, as unsigned forms cannot be processed, potentially impacting your benefits. Upon submission, your information will be reviewed by the Department of Human Services to determine your continued eligibility for the benefits. You may be contacted for further information or to clarify the details you've provided. Submitting this form on time and with the correct information is crucial in maintaining your assistance without interruption.

Listed Questions and Answers

Frequently asked questions about the Illinois Link Redetermination form are provided to offer clarity and assistance in completing and submitting this crucial document. These responses aim to simplify the process and ensure that individuals continue to receive the benefits they need without interruption.

  1. What is the Link Illinois Redetermination form?

    The Link Illinois Redetermination form is a document required by the State of Illinois Department of Human Services. It is used to evaluate if individuals or families continue to qualify for benefits like SNAP (Supplemental Nutrition Assistance Program) and TANF (Temporary Assistance for Needy Families). This form needs to be completed and submitted periodically to ensure uninterrupted benefits.

  2. Why do I need to complete this form?

    It is essential to complete and submit this form to maintain your eligibility for state assistance programs. The form allows the Department of Human Services to assess changes in your household, income, or residence that may affect your benefits. Failure to submit the form by the due date can result in the termination of your benefits.

  3. What information do I need to provide when completing the form?

    • Details of all persons living with you, including their full name, birth date, and relationship to you.
    • Information about any changes to health insurance if you receive an HFS Medical Card.
    • Employment details for anyone in your household, including recent pay stubs or income statements if self-employed.
    • Any other sources of income received in the last 30 days.
    • Expected changes in income or employment.
    • New address details if you have moved or changed your address.
    • Housing costs and whether these are partially covered by another party.
    • Details regarding utility assistance, child support payments, childcare expenses, educational status for those over 18, and medical expenses for those 60 or older or disabled.
  4. How often must I complete and submit the Redetermination form?

    The frequency of this requirement can vary based on the specifics of your case. Generally, the Department of Human Services will send you a notice when it is time to complete and submit a new Redetermination form. It is typically required on an annual basis but may be more frequent for certain circumstances.

  5. Where do I send the completed Redetermination form?

    You should return the completed form in the enclosed envelope provided by the Department of Human Services. Alternatively, you can bring the form to your scheduled appointment. Ensure the form is signed, as unsigned forms are considered invalid.

  6. What happens if I don't submit the form by the due date?

    If the form isn't submitted by the specified due date, your benefits may be suspended or terminated. It is crucial to submit the form on time to avoid an interruption in assistance.

  7. Can I provide additional information if someone in my household has started or stopped working after submitting the form?

    Yes. If there are any changes to your employment situation after submitting the Redetermination form, you should inform the Department of Human Services as soon as possible. These changes may affect your eligibility and the amount of benefits you receive.

  8. Who can I contact if I have questions while completing the form?

    If you have questions or need assistance with the Redetermination form, you can contact the Department of Human Services directly. Use the phone number provided on the form or the notice you received to get in touch with a representative who can help.

Common mistakes

  1. Not listing all individuals living in the household, including those who do not share food with the household. It's crucial to include everyone, as this affects eligibility and benefit levels.

  2. Forgetting to attach proof of income, such as pay stubs or an income and expense statement for the self-employed. This oversight can delay the processing of the application or lead to a denial of benefits.

  3. Omitting changes in income, including starting a new job, ending a job, or any other adjustments to income. Accurate and up-to-date income information is essential for determining the correct benefit amount.

  4. Failing to report other sources of income such as Child Support, Social Security, SSI, or Unemployment benefits. All income sources must be disclosed to properly assess eligibility.

  5. Not updating household information, like a change in address or changes in monthly expenses such as rent, mortgage, taxes, and homeowner's insurance. This information can impact eligibility and the amount of benefits received.

  6. Skip reporting any received energy assistance payments or changes in utility payment responsibilities. This can affect the household's expense calculations and, consequently, the benefits for which they are eligible.

  7. Ignoring the signature requirement at the end of the form. A signature is necessary to verify that the information provided is accurate and complete. An unsigned form is considered invalid and will not be processed.

Documents used along the form

Applying for or renewing benefits through the Illinois Redetermination form is part of a critical process to ensure continuity in receiving assistance. However, this form is often just one piece of the application puzzle. Several other documents typically accompany this form to provide a comprehensive view of an individual's or family's situation. Understanding these documents can help streamline the application or renewal process, ensuring that all needed information is submitted promptly and accurately.

  • Proof of Income: This includes recent pay stubs, tax returns, or a statement from an employer. For self-employed individuals, a detailed income and expense report is necessary. This document shows the state your current financial situation and proves your eligibility for the program.
  • Proof of Residency: Utility bills, a lease agreement, or a mortgage statement can serve as proof of residency. It confirms that you live in Illinois and are applying for benefits in the correct state.
  • Identification Documents: A valid state ID, driver's license, or birth certificate is required to verify the identities of everyone in the household. This step is crucial for preventing fraud and ensuring benefits go to the rightful recipients.
  • Proof of Expenses: Receipts for rent, mortgage payments, utility bills, and child care expenses show how much of your income goes toward essential living costs. This helps determine the amount of assistance you qualify for.
  • Medical Expense Records: For households with elderly or disabled members, documenting medical expenses, including insurance premiums, doctor visit co-pays, prescriptions, and any out-of-pocket medical expenses, is essential. These expenses can impact the amount of benefits received.
  • Child Support Documentation: If you pay or receive child support, court orders, or receipts showing the payment amounts provide proof of these financial arrangements. This information can affect your eligibility and benefit level.

When gathering documents to accompany your Link Illinois Redetermination form, it's helpful to check each item against the DHS's requirements. Accurate and thorough documentation supports a smoother review process, potentially preventing delays in receiving assistance. Remember, the objective is to give a full picture of your financial situation, household composition, and any changes since your last application or renewal. By doing so, you help ensure that your application or renewal is processed efficiently, maintaining the support you need.

Similar forms

  • Unemployment Benefit Application: Similar to the Link Illinois Redetermination form, an unemployment benefit application requires individuals to provide detailed information about their current employment status, any income they're receiving, and their availability for work. Both documents are designed to assess eligibility for benefits, necessitating accurate, timely information regarding one’s financial and employment situations.

  • Supplemental Nutrition Assistance Program (SNAP) Application: This form is quite similar to the Redetermination form, as both are used to evaluate eligibility for nutritional assistance based on household income, expenses, and composition. Applicants must disclose details about all household members, income sources, and employment, paralleling the redetermination process which ensures ongoing need and eligibility for benefits.

  • Temporary Assistance for Needy Families (TANF) Application: Like the Link Illinois Redetermination form, a TANF application gathers comprehensive information on family composition, income, and resources to determine qualification for cash assistance. Both documents are crucial for families seeking governmental support, mandating updates on financial conditions and familial changes that could influence benefit eligibility.

  • Medicaid Redetermination Form: Medicaid redetermination and the Link Illinois Redetermination form share a common purpose: verifying ongoing eligibility for benefits. Each requires current details on income, household changes, and in some cases, healthcare coverage, to maintain individuals’ and families’ access to essential services, such as healthcare or nutritional support.

  • Low Income Home Energy Assistance Program (LIHEAP) Application: LIHEAP applications, similar to the energy assistance portion of the Link Illinois Redetermination form, ask about utility expenses and assistance needs to offer financial support for heating and cooling expenses. Both forms play a vital role in ensuring families do not have to choose between food, medicine, and keeping their homes at a safe temperature.

Dos and Don'ts

When completing the Link Illinois Redetermination form, it's important to understand the do's and don'ts to ensure the process is smooth and the application is accurate. Here are seven key points to consider:

Do's:
  • Verify your personal information: Ensure your name, address (if not pre-filled on the form), and contact information are correctly entered.
  • List all household members accurately: Include everyone living with you, their relationship to you, and whether they eat with you.
  • Report income correctly: Whether it’s from employment, child support, or any other source, accurately report the income of all household members. Attach the required documentation, such as pay stubs or income statements.
  • Notify changes in your circumstances: Inform of any job starts, job endings, income changes, or address changes as these can affect your benefits.
  • Include information on additional expenses: Report your rent, mortgage, utilities, child support payments, and childcare expenses accurately.
  • Answer all questions truthfully: From questions about school attendance to medical expenses or drug convictions, it's crucial to respond to all items candidly.
  • Sign and date the form: Your signature is required to validate the application ensuring all provided information is accurate to the best of your knowledge.
Don'ts:
  • Do not leave sections blank: If a question does not apply to you, make sure to indicate with a “No” or “Not Applicable,” rather than leaving it empty.
  • Do not guess information: If you’re unsure about specific details like income amounts or expenses, take the time to verify them before submission.
  • Do not omit any household members: Failing to list all individuals living in your household can lead to inaccuracies in your application.
  • Do not forget to report all types of income: Overlooking to report any income, including tips or non-traditional employment, can affect the determination of your benefits.
  • Do not ignore the documentation requirements: Neglecting to attach necessary documents such as pay stubs or income statements can delay the processing of your application.
  • Do not provide false information: Misreporting your circumstances or financial information could lead to the denial of benefits or legal consequences.
  • Do not forget to update changes: If any information changes after you've submitted the form, it’s important to inform the Department of Human Services promptly.

Misconceptions

There are several misconceptions about the Link Illinois Redetermination form which may confuse individuals trying to navigate the process of maintaining their benefits. Understanding these can help in ensuring that the benefits continue without unnecessary interruptions.

  • Misconception 1: Every section of the form must be filled out by all applicants.

    Not all sections will apply to everyone. It’s important to read each question carefully and only provide information that is relevant to your current situation.

  • Misconception 2: You only need to report your income if it has changed since your last application.

    Even if your income has not changed, you are required to report your current income accurately to ensure that your benefits calculation is correct.

  • Misconception 3: If you receive TANF Cash, you do not need to complete the Link Illinois Redetermination form for your SNAP benefits.

    Individuals receiving TANF Cash must complete the form to continue both their cash benefits and their SNAP benefits.

  • Misconception 4: You do not need to report income from odd jobs or self-employment.

    All sources of income, including self-employment and odd jobs, must be reported to accurately assess eligibility for continued benefits.

  • Misconception 5: Changes in employment status or income expected after the submission of the form do not need to be reported.

    Expected changes to your income or employment status should be reported on the form as they can affect your benefits.

  • Misconception 6: You do not need to report changes in household size unless someone moves out.

    Both additions and subtractions to your household size can affect your benefits and need to be reported.

  • Misconception 7: LIHEAP payments will reduce the amount of SNAP benefits you can receive.

    Receiving assistance from LIHEAP does not affect the calculation of your SNAP benefits, and such payments should be reported.

  • Misconception 8: If no one in your household has changed jobs or income sources, you do not need to complete the employment sections.

    Current employment information is required for all household members who are working, regardless of whether there have been any changes.

Understanding and addressing these misconceptions can streamline the process of completing the Link Illinois Redetermination form, helping ensure that there are no disruptions in receiving benefits. It’s crucial to provide complete and accurate information tailored to your specific situation to maintain your eligibility and the correct level of benefits.

Key takeaways

Filling out the Link Illinois Redetermination form is a crucial step in maintaining your eligibility for certain benefits. Here are key takeaways to remember when completing and using this form:

  • Timeliness is key. Ensure the form is returned by the due date indicated on the notice to avoid disruption in benefits. This can be done either through the mail in the provided envelope or in person at a scheduled appointment.
  • Signature requirement. The form must be signed to be considered valid. Without a signature, the redetermination cannot be processed, potentially leading to a lapse in benefits.
  • Report all household members. It's crucial to list everyone living with you, including their full name, birth date, and relationship to you. If space is insufficient, attach a separate sheet for additional persons.
  • Income verification is necessary. If anyone in the household is employed, attaching relevant pay stubs or an income and expense statement for self-employed individuals is required. Also, reporting any other forms of income, like child support or social security, is needed for accurate determination.
  • Changes in employment status matter. Informing about any new jobs, cessation of employment, or any expected changes in income or employment is essential for the current assessment period.
  • Update housing and utility details. Changes in address, rent or mortgage amounts, and utility payments should be accurately reported. This includes energy assistance received, as it can affect calculations for benefits.
  • Health, childcare, and educational expenses count. Reporting monthly medical expenses for those 60 or older or disabled, child care expenses to enable work, job search, or training, and school attendance for those 18 or over is necessary for a comprehensive evaluation.

Accurately filling out and promptly returning the Link Illinois Redetermination form ensures that your benefits can be correctly reassessed and continued without interruption. Pay close attention to all sections and provide detailed, truthful information to help the State of Illinois Department of Human Services make an informed decision about your continuing eligibility.

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