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Blank Link Illinois Redetermination PDF Form

The Link Illinois Redetermination form is an essential document required by the State of Illinois Department of Human Services to ensure the continued eligibility of individuals for SNAP and TANF benefits. This form must be completed and returned by the specified due date to prevent any interruption in benefits. To maintain your benefits, please fill out the form by clicking the button below.

Article Guide

The Link Illinois Redetermination form is a crucial document for individuals and families receiving benefits from the State of Illinois Department of Human Services. This form must be completed to ensure the continuation of essential support programs, including the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). Recipients are notified of their need to submit this form, and it is vital to return it by the specified due date to avoid any interruption in benefits. The form requires detailed information about all household members, including their names, birth dates, and relationships. Additionally, it seeks updates on income, employment status, and any changes in circumstances, such as new jobs or changes in health insurance. Important financial details are also requested, including rent or mortgage payments and any other sources of income. The form emphasizes the importance of accuracy and honesty, as signing it affirms that the information provided is true to the best of one’s knowledge. Completing this form is a necessary step to maintain access to vital resources, and it is designed to be straightforward, allowing individuals to navigate the process with confidence.

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	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 File

Form Specifications

Fact Name	Description
Purpose	The Link Illinois Redetermination form is used to assess eligibility for continued SNAP and TANF benefits.
Due Date	It is essential to return the form by the specified due date to avoid interruption in benefits.
Signature Requirement	The form must be signed to be considered a valid application.
Income Reporting	Applicants must report all sources of income, including employment and other benefits.
Housing Costs	Details about rent, mortgage, and utilities must be provided to determine eligibility.
Changes in Circumstances	Applicants should report any changes in income or employment status that may affect benefits.
Governing Law	This form is governed by the Illinois Department of Human Services regulations for public assistance programs.

Link Illinois Redetermination: Usage Guidelines

Completing the Link Illinois Redetermination form is an important step to ensure your benefits continue without interruption. After filling out the form, you must return it by the specified due date or bring it to your scheduled appointment. It is essential to provide accurate information and sign the form for it to be valid.

Write your name and address in the space provided if it is not already on the form.
Fill in the date of notice, case ID, phone number, and caseload information.
List all persons living with you, including yourself, along with their birth dates and relationships to you.
Indicate if you receive an HFS Medical Card and if your health insurance has changed.
Answer whether anyone in your household is paid for working. If yes, provide their names and attach the required pay stubs or income statements.
Specify if anyone started a new job or stopped working. If applicable, include details about the job ending.
Report any other income received in the last 30 days, such as Child Support or Social Security. Provide names, types of income, amounts, and frequency.
Indicate if you expect any changes in income or employment and describe those changes.
State whether you have moved or changed your address, providing the new address if applicable.
List your rent, lot rent, mortgage, and any taxes or homeowner's insurance paid separately. Indicate if someone else pays any of these expenses.
Answer whether you received energy assistance payments and if you pay for utilities separately from your rent or mortgage.
Indicate if anyone pays child support, providing details about who makes the payments and the amounts.
State if you pay for someone to care for a child or disabled adult to enable you to work or receive training.
Confirm if anyone age 18 or over attends school half-time or more.
Answer whether someone in your unit who is 60 or older or disabled has monthly medical expenses of $36 or more.
Indicate if any person receiving Cash assistance has been convicted of a felony involving drugs.
Sign the form, providing your daytime or cell phone number and the date of signing.

Your Questions, Answered

What is the Link Illinois Redetermination form?

The Link Illinois Redetermination form is a document required by the Illinois Department of Human Services (DHS) for individuals receiving SNAP (Supplemental Nutrition Assistance Program) benefits and TANF (Temporary Assistance for Needy Families) cash assistance. This form helps determine whether recipients still qualify for these benefits based on their current circumstances.

When should I submit the Redetermination form?

You should submit the Redetermination form by the due date indicated on your notice. To ensure that you continue receiving benefits without interruption, complete and return the form in the enclosed envelope or bring it to your scheduled appointment.

What information do I need to provide on the form?

The form requires you to list all individuals living with you, their income, any changes in employment, and details about your housing costs. You will also need to provide information about any other income sources, child support payments, and utility expenses.

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

If you do not return the form by the due date, your SNAP benefits may end. It is crucial to submit the form on time to avoid any disruptions in your assistance.

Do I need to sign the Redetermination form?

Yes, the form must be signed to be considered valid. Your signature confirms that the information you provided is accurate to the best of your knowledge.

What should I do if my situation changes after I submit the form?

If your situation changes after submitting the form—such as a new job, change in income, or moving to a new address—you should notify the DHS immediately. Keeping them informed helps ensure that your benefits are adjusted appropriately.

Can I get help filling out the form?

If you need assistance with the form, you can reach out to local community organizations or the DHS office. They can provide guidance and help ensure that you complete the form correctly.

What if I receive both SNAP and TANF benefits?

If you receive both SNAP and TANF benefits, you must complete the Redetermination form for both programs. Your continued eligibility for each benefit is assessed based on the information provided in the form.

What types of income do I need to report?

You must report all sources of income, including wages from employment, child support, Social Security, unemployment benefits, and any other financial assistance. Be sure to include details about how often you receive this income.

Is there a penalty for providing false information on the form?

Yes, providing false information on the Redetermination form can lead to serious consequences, including loss of benefits and potential legal repercussions. It is essential to be truthful and accurate when completing the form.

Common mistakes

Failing to list all household members. It is crucial to include every person living with you, as omitting individuals may lead to delays or denial of benefits.
Not signing the form. The application will not be considered valid unless it is signed. A missing signature can result in immediate rejection.
Neglecting to provide required income documentation. If anyone in the household is working, attach the necessary pay stubs or income statements. Failing to do so can hinder the processing of your application.
Overlooking changes in employment or income. If there have been any changes, such as a new job or loss of employment, it is important to report these accurately.
Not reporting all sources of income. This includes child support, Social Security, and any other financial assistance. Incomplete information can affect eligibility.
Forgetting to update address changes. If you have moved, it is essential to provide your new address to ensure you receive all communications regarding your benefits.
Ignoring questions about utility payments. Be sure to disclose any assistance received for utilities or payments made by others, as this information is relevant to your application.
Not providing details about child care expenses. If you pay for child care to work or seek employment, include all relevant details, as this may affect your benefit calculations.
Failing to indicate if anyone has been convicted of a felony involving drugs. This information is critical and should be answered truthfully to avoid complications.

Documents used along the form

The Link Illinois Redetermination form is a crucial document for individuals seeking to maintain their benefits under the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF). Along with this form, several other documents are often required to ensure a smooth redetermination process. Below are some commonly used forms and documents that may accompany the Link Illinois Redetermination form.

Pay Stubs: Applicants must provide copies of recent pay stubs to verify income. This includes the last four pay stubs for weekly pay, two for bi-weekly, or one for monthly pay. If self-employed, an income and expense statement is necessary.
Income Verification Form: This form collects information about all sources of income, including child support, Social Security, and unemployment benefits. It helps the agency assess eligibility based on total household income.
Housing Expense Documentation: This includes proof of rent or mortgage payments, taxes, and homeowner's insurance. It may also require documentation of any assistance received for housing costs.
Utility Bills: Applicants may need to submit recent utility bills to demonstrate their household expenses. This helps in evaluating any additional benefits that may be applicable based on utility costs.

Gathering these documents in advance can streamline the redetermination process and ensure that benefits continue without interruption. It is essential to follow the guidelines and submit all necessary information by the specified deadlines.

Similar forms

Food Stamp Application: Similar to the Link Illinois Redetermination form, this document is used to apply for or renew eligibility for food assistance programs. Both require personal and financial information to determine ongoing eligibility.
TANF Application: The Temporary Assistance for Needy Families (TANF) application also assesses financial need and household composition. Like the redetermination form, it requires information on income and employment status.
Medicaid Application: This form is used to apply for health coverage for low-income individuals. It shares similarities in collecting personal information and verifying income to determine eligibility.
Housing Assistance Application: This document is used to apply for subsidized housing. It requires details about income, household members, and expenses, much like the redetermination form.
Child Care Assistance Application: This application assesses eligibility for financial help with child care costs. It also gathers information about household income and employment, paralleling the redetermination process.
Unemployment Benefits Application: When applying for unemployment benefits, individuals must provide personal and financial information to determine eligibility. This is similar to the information required in the redetermination form.
Supplemental Security Income (SSI) Application: This form is used to apply for financial assistance for individuals with disabilities. It requires personal and financial details, akin to the redetermination form.
Low Income Home Energy Assistance Program (LIHEAP) Application: This application helps low-income households pay for heating and cooling costs. It collects similar income and household information as the redetermination form.

Dos and Don'ts

When filling out the Link Illinois Redetermination form, it’s essential to approach the task with care and attention to detail. Here are some important dos and don'ts to keep in mind:

Do read the entire form carefully before starting. Understanding what information is required will make the process smoother.
Do provide accurate and complete information for all household members. Include full names and birth dates.
Do sign the form before submission. A signature is necessary for the application to be valid.
Do attach any required documents, such as pay stubs or income statements, as specified in the instructions.
Don't leave any sections blank. If a question does not apply, write "N/A" to indicate that it has been considered.
Don't forget to check the due date. Submitting the form late may result in a loss of benefits.
Don't provide false information. Misrepresentation can lead to serious consequences, including penalties or loss of benefits.
Don't hesitate to ask for help if you are unsure about any part of the form. Local assistance agencies can provide guidance.

By following these guidelines, you can help ensure that your application process goes as smoothly as possible. Take your time, double-check your answers, and don’t hesitate to seek assistance if needed.

Misconceptions

The Link Illinois Redetermination form is essential for maintaining your benefits, but several misconceptions may lead to confusion. Here are four common misunderstandings:

Misconception 1: The form is optional for continuing benefits.

In reality, completing and submitting this form is mandatory. If you do not return it by the due date, your benefits will end. It is crucial to adhere to the deadlines provided.

Misconception 2: Only income from employment needs to be reported.

This is not accurate. All sources of income must be disclosed, including Child Support, Social Security, and Unemployment benefits. Failing to report all income can jeopardize your eligibility.

Misconception 3: You can submit the form without a signature.

Without a signature, the application is considered invalid. Make sure to sign the form before submission to ensure it is processed correctly.

Misconception 4: Changes in living arrangements do not need to be reported.

This is incorrect. If you have moved or changed your address, you must inform the authorities by providing your new address on the form. Keeping your information updated is essential for continued eligibility.

Key takeaways

Here are some key takeaways about filling out and using the Link Illinois Redetermination form:

Complete the form on time: Submit the form by the due date to ensure your benefits continue without interruption.
Provide accurate information: List all individuals living with you and ensure their details are correct.
Report income changes: Include any income from jobs, child support, or other sources. Attach necessary documentation like pay stubs.
Indicate changes in circumstances: Notify if anyone has started or stopped working, or if there are changes in income.
Keep track of expenses: Provide accurate information about your rent, mortgage, and any other expenses related to housing and utilities.
Sign the application: Your signature is required for the application to be valid. Make sure to sign and date the form.

Following these steps can help you maintain your benefits and avoid delays in processing your application.