Fill a Valid Link Illinois Redetermination Form

The Link Illinois Redetermination form is a crucial document for individuals receiving benefits from the State of Illinois. This form must be completed and submitted to ensure the continuation of benefits such as SNAP and TANF Cash. To maintain your eligibility, it is essential to fill out the form accurately and return it by the specified due date.

Take action now to secure your benefits by filling out the form. Click the button below to get started.

Open Link Illinois Redetermination Editor

Open Link Illinois Redetermination Editor

Table of Contents

The Link Illinois Redetermination form serves as a critical tool for individuals and families receiving assistance through the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). This form must be completed and returned to ensure the continuation of benefits without interruption. Recipients are required to provide detailed information about their household composition, including the names, birth dates, and relationships of all individuals living in the home. Additionally, the form prompts applicants to disclose any changes in employment, income, or health insurance status, which are essential for determining ongoing eligibility. It also requires information about housing costs, utility payments, and any child support obligations. By signing the form, applicants affirm that the information provided is accurate, underscoring the importance of honesty in the application process. Failure to submit the form by the specified due date may result in the loss of benefits, making timely completion crucial. Therefore, understanding the components and requirements of the Link Illinois Redetermination form is vital for maintaining necessary support for those in need.

Example - Link Illinois Redetermination Form


	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
				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	Page 1 of 2

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

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

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

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			Page 2 of 2
Printed by the Authority of the State of Illinois	PO #15-0229 12,000 Copies

▼ PDF

Document Breakdown

Fact Name	Details
Governing Law	The Link Illinois Redetermination form is governed by the Illinois Public Aid Code, 305 ILCS 5/1 et seq.
Purpose	This form is required for individuals receiving SNAP and TANF benefits to verify their continued eligibility.
Submission Deadline	Applicants must return the completed form by the due date specified in the notice to avoid interruption of benefits.
Signature Requirement	The form must be signed by the applicant to be considered valid and processed.
Income Reporting	Applicants must report all sources of income, including employment and other benefits, to ensure accurate assessment of eligibility.

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