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Outline

The Link Illinois Redetermination form is a crucial document for individuals and families seeking to maintain their Supplemental Nutrition Assistance Program (SNAP) benefits and Temporary Assistance for Needy Families (TANF) cash assistance. This form must be completed and submitted to ensure continued eligibility for these essential benefits. When filling out the form, applicants will need to provide detailed information about their household, including the names and relationships of all individuals living together. It is important to report any changes in income, employment, or household circumstances, as these can affect benefit amounts. The form also requires information about rent or mortgage payments, utility costs, and any additional income sources, such as child support or Social Security. Timely submission is critical; failure to return the form by the due date may result in the loss of benefits. Signing the form is mandatory, as it affirms that the information provided is accurate to the best of the applicant's knowledge. This process not only helps maintain financial support but also ensures that the Department of Human Services can accurately assess ongoing eligibility.

 

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 Information

Fact Name Description
Governing Law The Link Illinois Redetermination form is governed by the Illinois Public Aid Code.
Purpose This form is used to determine continued eligibility for SNAP and TANF benefits.
Submission Deadline Applicants must return the form by the specified due date to avoid interruption of benefits.
Signature Requirement A valid application requires the applicant's signature on the form.
Household Information All persons living in the household must be listed, including their birth dates and relationships.
Income Reporting Applicants must report all sources of income, including employment and other benefits.
Changes in Employment Any changes in employment status, such as starting or stopping a job, must be reported.
Medical Expenses Monthly medical expenses for individuals aged 60 or older or disabled may affect eligibility.
Child Support Payments Applicants must disclose any child support payments made or received, including amounts and frequency.

Completing the Link Illinois Redetermination form is an important step to ensure that you continue receiving your benefits without interruption. After filling out the form, you must return it by mail or bring it to your scheduled appointment. Make sure to sign the form; an unsigned form will not be considered valid.

  1. Begin by writing your name and address in the designated space if they are not already on the form.
  2. List all persons living with you, including yourself. Provide their full name, birth date, and relationship to you. Indicate whether they eat with you.
  3. If you have an HFS Medical Card, indicate whether your health insurance has changed by marking 'Yes' or 'No.'
  4. Answer if anyone in your household gets paid for working. If 'Yes,' provide their names and attach the required pay stubs based on their pay frequency.
  5. Indicate if anyone started a new job or stopped working. If applicable, fill in the details regarding the job change.
  6. Report any other income received in the last 30 days, such as Child Support or Social Security. Fill in the details in the provided box.
  7. Answer whether you expect any changes in income or employment for anyone in your household.
  8. Indicate if you have moved or changed your address. If 'Yes,' provide your new address.
  9. List your rent, lot rent, mortgage, and any taxes or homeowner's insurance paid separately. Specify if any of these are paid by someone else.
  10. Answer whether you received an energy assistance payment of $21 or more in the last 12 months. If 'No,' indicate if you pay for any utilities and provide details.
  11. Indicate if anyone in your household pays child support. If 'Yes,' provide the details.
  12. Answer whether you pay for someone to care for a child or disabled adult so you can work or train. If 'Yes,' give the necessary details.
  13. Indicate if anyone aged 18 or over attends school, other than high school, half-time or more.
  14. Answer whether someone aged 60 or older or disabled has monthly medical expenses of $36 or more.
  15. Indicate if anyone receiving Cash assistance has been convicted of a felony involving drugs.
  16. Finally, sign the form and provide your daytime or cell phone number along with the date.
  1. What is the purpose of the Link Illinois Redetermination form?

    The Link Illinois Redetermination form is used to assess ongoing eligibility for benefits such as SNAP (Supplemental Nutrition Assistance Program) and TANF (Temporary Assistance for Needy Families). Completing this form ensures that individuals and families can continue receiving the necessary financial support for food and cash assistance. It is important to return the form by the specified due date to avoid interruption of benefits.

  2. Who needs to complete the form?

    All individuals receiving SNAP benefits must complete the Link Illinois Redetermination form. If you are also receiving TANF cash benefits, it is mandatory to fill out this form to ensure that those benefits continue as well. The form must include information about all persons living in the household, including their income and any changes in circumstances.

  3. What information is required on the form?

    The form requires detailed information about household members, income sources, employment status, and any changes in circumstances. Specifically, you will need to provide:

    • Names and birth dates of all household members
    • Details about employment, including employer names and pay rates
    • Information on any additional income received
    • Housing costs such as rent or mortgage
    • Any changes in address

    Completing all sections accurately is crucial for the redetermination process.

  4. What happens if I do not return the form by the due date?

    If the Link Illinois Redetermination form is not returned by the due date, your SNAP benefits may end. It is essential to submit the form on time to avoid any lapse in assistance. You can either mail the form in the enclosed envelope or bring it to your scheduled appointment.

  5. Can I get help with completing the form?

    Yes, assistance is available for individuals who need help completing the Link Illinois Redetermination form. You can reach out to local community organizations or the Department of Human Services for guidance. It is important to ensure that the form is filled out accurately to avoid any delays in processing your benefits.

Common mistakes

Filling out the Link Illinois Redetermination form can be straightforward, but many people make common mistakes that can lead to delays or denial of benefits. One significant error is failing to list all household members accurately. It is essential to include everyone living with you, as omitting a person can affect eligibility. Always double-check the names, birth dates, and relationships to ensure they are correct.

Another frequent mistake is not signing the form. The application is considered invalid without a signature. Many individuals overlook this crucial step, thinking that completing the form is sufficient. Remember, a signature confirms that you affirm the information provided is true.

People also often forget to provide necessary documentation. If someone in the household is working, you must attach the required pay stubs. This includes the last four pay stubs for weekly pay, two for bi-weekly, and one for monthly pay. Neglecting to include these documents can lead to complications in processing your application.

Additionally, many applicants fail to report all sources of income. If anyone in the household receives income from child support, Social Security, or other sources, it must be disclosed. Leaving out any income can result in inaccurate assessments of your eligibility.

Another common oversight is not updating the address if you have moved. If your address has changed, it is crucial to provide the new information. Failing to do so can lead to missed notifications or benefits being sent to the wrong address.

People sometimes misunderstand questions about changes in income or employment. If there are any expected changes, such as a new job or a job loss, you must provide details. Ignoring this question can lead to assumptions about your financial situation that may not be accurate.

Some applicants also skip over questions regarding utility payments. It is important to indicate whether you pay for utilities separately from rent or mortgage. This information can impact your benefits, so be thorough in your responses.

Lastly, many individuals forget to provide a contact number. Including a daytime or cell phone number is vital for communication. If there are questions or issues with your application, having a phone number allows for quicker resolution.

Documents used along the form

The Link Illinois Redetermination form is an important document for those receiving benefits in Illinois. It helps ensure that individuals and families continue to receive the assistance they need. Along with this form, there are several other documents that are often required or helpful in the process of maintaining benefits. Here’s a list of some commonly used forms and documents.

  • Application for Benefits Eligibility (ABE) - This form is used to apply for various state assistance programs, including SNAP and TANF. It collects personal information and income details.
  • Verification of Employment - This document confirms an individual's employment status and income. It may include pay stubs or a letter from the employer.
  • Income and Expense Statement - Self-employed individuals often use this form to report their earnings and expenses, giving a clearer picture of their financial situation.
  • Child Support Verification - If a household receives child support, this form is used to document the amount and frequency of payments received.
  • Medical Expense Verification - This document is necessary for those claiming medical expenses for a household member, especially for those over 60 or disabled.
  • Housing Verification Form - This form provides details about a household's housing situation, including rent or mortgage payments, which can affect benefit eligibility.
  • Utility Expense Statement - For those claiming utility costs, this document outlines monthly expenses for services like electricity, gas, and water.
  • Change of Address Form - If a household moves, this form is essential to update the address for benefits and ensure continued communication.
  • Asset Verification Form - This document is used to report any significant assets owned by the household, which may impact eligibility for assistance programs.
  • School Enrollment Verification - For those with dependents attending school, this form confirms their enrollment status, which can affect benefits.

Having these documents ready can make the redetermination process smoother. It’s always a good idea to check what specific forms are required for your situation to ensure you maintain your benefits without interruption.

Similar forms

  • SNAP Application Form: Like the Link Illinois Redetermination form, this application collects detailed information about household income and expenses to determine eligibility for food assistance.
  • TANF Application Form: Similar to the redetermination form, this document requires information on household composition and income to assess eligibility for cash assistance.
  • Medicaid Application Form: This form, like the redetermination form, gathers personal and financial information to evaluate eligibility for medical benefits.
  • Child Care Assistance Application: This application requests details about income and employment, mirroring the redetermination form's focus on financial stability and employment status.
  • Energy Assistance Application: Similar to the redetermination form, it asks about household income and utility expenses to determine eligibility for energy assistance programs.
  • Unemployment Benefits Application: This document collects information about work history and income, paralleling the redetermination form's inquiry into employment and earnings.
  • Housing Assistance Application: Like the redetermination form, this application requires details on rent or mortgage payments and household income to assess eligibility for housing support.
  • Social Security Disability Application: This form requests comprehensive personal and financial information to determine eligibility for disability benefits, akin to the redetermination form's requirements.
  • Supplemental Security Income (SSI) Application: Similar to the redetermination form, it collects detailed information about income, resources, and living arrangements to evaluate eligibility for financial support.
  • Veterans Benefits Application: This application gathers information about income and expenses, similar to the redetermination form, to assess eligibility for various veteran assistance programs.

Dos and Don'ts

When filling out the Link Illinois Redetermination form, it's crucial to ensure accuracy and completeness. Here’s a list of essential do's and don'ts to guide you through the process.

  • Do read the entire form carefully before starting.
  • Do provide all required personal information, including your name and address.
  • Do list all individuals living with you, including their full names and birth dates.
  • Do attach necessary documentation, such as pay stubs or income statements.
  • Do sign the form to validate your application.
  • Don't leave any sections blank; incomplete forms may delay your benefits.
  • Don't submit the form after the due date; timely submission is critical.
  • Don't forget to report any changes in income or employment status.
  • Don't provide false information; this could lead to serious consequences.
  • Don't hesitate to ask for help if you're unsure about any part of the form.

Following these guidelines will help ensure that your application is processed smoothly and efficiently. Your benefits depend on the accuracy and timeliness of your submission, so take the time to complete the form correctly.

Misconceptions

Understanding the Link Illinois Redetermination form can be challenging. Here are some common misconceptions that often arise:

  • Misconception 1: The form is optional for continuing benefits.
  • This is false. Completing and returning the form is mandatory to ensure that your benefits continue without interruption.

  • Misconception 2: You can submit the form after the due date without consequences.
  • Submitting the form late may result in a delay or loss of benefits. It's crucial to return it by the specified due date.

  • Misconception 3: Only the head of the household needs to fill out the form.
  • All individuals living in the household must be listed on the form, regardless of their relationship to the head of the household.

  • Misconception 4: You don’t need to report changes in income if they are temporary.
  • Any change in income, even if temporary, should be reported. This ensures that benefits are accurately calculated.

  • Misconception 5: If you don’t receive TANF, you don’t need to fill out the form.
  • Even if you don’t receive TANF, you must complete the form to maintain your SNAP benefits.

  • Misconception 6: You only need to provide information about income from employment.
  • All sources of income, including child support and social security, must be reported on the form.

  • Misconception 7: The form can be filled out quickly without gathering necessary documents.
  • While it may seem straightforward, having the correct documents, like pay stubs, is essential to complete the form accurately.

  • Misconception 8: You can skip questions if you think they don't apply to you.
  • It’s important to answer every question to the best of your ability. If a question doesn’t apply, indicate that clearly.

  • Misconception 9: Signing the form is just a formality.
  • Signing the form is a legal affirmation that the information provided is true. Providing false information can lead to serious consequences.

Key takeaways

Here are key takeaways regarding the Link Illinois Redetermination form:

  • Complete the form accurately to ensure continued receipt of benefits.
  • Submit the form by the specified due date to avoid interruption in benefits.
  • Sign the form; an unsigned form will not be processed.
  • List all household members, including yourself, and their relevant details.
  • Provide information on income sources and employment status for all working individuals in the household.
  • Report any changes in income, employment, or address promptly.
  • Include information about any child support payments made or received.
  • Indicate if anyone in the household has monthly medical expenses exceeding $36.
  • Understand that answering certain questions, like energy assistance, will not affect benefits negatively.