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Fill Out Your Il444 2378 B Form

The IL444 2378 B form is a crucial document used in the State of Illinois for requesting cash assistance, medical assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits. This form serves as an application platform, allowing individuals and families to access essential support when needed most. Completing this application can be the first step toward securing the financial aid you deserve. Begin the process by filling out the form linked below.

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The IL444 2378 B form is an essential document used by individuals applying for various financial assistance programs in the state of Illinois. This form facilitates requests for Cash Assistance, Medical Assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits. When completing this form, applicants must provide personal information including their name, address, date of birth, and Social Security Number. The form requires individuals to disclose whether they are homeless and permits the nomination of an approved representative for assistance throughout the application process. Detailed instructions guide applicants on the filing process, emphasizing the necessity of signing particular pages to initiate application processing. Each applicant is also asked to provide information about their household composition, disability status, and citizenship or immigration status, among other criteria. Clarity on eligibility timelines, particularly for SNAP benefits, is provided, setting expectations on when a decision will be made. Understanding and correctly filling out the IL444 2378 B form is crucial for residents seeking vital support services from the Illinois Department of Human Services.

Il444 2378 B Example

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Last Name:

First Name:

MI:

Maiden Name:

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Present Address:

Apartment Number:

City:

State:

Zip Code:

County:

Birth Date:

Social Security Number:

Are you homeless?

Yes

Mailing Address (if different from above):

City:

State:

Zip Code:

County:

Telephone number(s) Home:

Work:

Other:

Daytime phone:

Best time to call you:

Signing here will start your application. You must sign Page 18 before we approve you for any benefits.

Signature:

Date:

Approved Representative

When you sign to have an approved representative it means you give permission for this person (1) to sign your application for you, (2) to receive official information about this application, and (3) to act for you on all matters with this agency.

Do you want to name an approved representative? Yes No If yes, complete the following:

Name of approved representative:					Address:
Phone Number:			Organization Name:				ID # if applicable:

Signature of applicant:

Instructions to person(s) applying for Cash, Medical, and/or SNAP benefits

Cash -

Medical -

SNAP -

1.Please print all of your answers on the application form so that we can read and understand your answers.

2.You have the right to immediately file the application as long as the top of this page (Page 1) is completed with your name, address and signature. The filing of this signed page (Page 1) starts the application processing timetable. Providing your date of birth and Social Security Number on this signed page will help us with the application registration process.

3.Read pages 14 & 15 to know your rights and responsibilities for SNAP benefits.

Read pages 16, 17 and 18 to know your rights and responsibilities for Cash and Medical benefits.

4.Before you can get any benefits, you must sign page 18.

5.If applying for SNAP benefits, a decision on your eligibility will be made within 30 days. If determined eligible, SNAP benefits will be issued from the date the application is filed.

6.You may be entitled to receive SNAP benefits right away if:

*your gross nonexempt income and liquid assets are less than your monthly rent or mortgage payment and the appropriate utility standard: or,

*you have assets of $100 or less and

-your gross monthly income for the month of application is less than $150; or

-at least one person applying is a migrant who is "out of funds."

7.This application must be filed with the Illinois Department of Human Services (IDHS). You may complete this form at home and return it to your local Family Community Resource Center (FCRC) in person or by mail. You have the right to choose the office where you apply. Use the IDHS Office Locator to find an FCRC at www.dhs.state.il.us/page.aspx?module=12 or call the IDHS Helpline at 1-800-843-6154. You may also mail this form to the Central Scan Unit (CSU), P.O. Box 19138, Springfield, IL 62763. You can also apply for benefits at ABE.illinois.gov or by calling the IDHS Helpline at 1-800-843-6154. Another member of the household or an adult who knows you may complete and return the form to us also. If someone else completes this form for the household, they are to answer the questions for the person(s) they are applying for, not himself or herself.

8.If you want to register to vote, fill out the enclosed Illinois Voter Registration Application (SBE R-19) and give it to your IDHS Family Community Resource Center (FCRC) or your local election official. For help filling it out or for translation services, contact your IDHS Family Community Resource Center (FCRC). You may also call the Helpline at 1-800-843-6154, or 1-866-324-5553 TTY/Nextalk, 711 TTY Relay. For information online, see www.dhs.state.il.us or www.elections.il.gov/. Filling out the Voter Registration Application as part of this application is optional. Registering to vote is your choice and will not affect the amount of benefits you get from this agency.

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 1 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Citizenship/Immigration Status

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If you or any other persons are not applying because you do not wish to provide information about your immigration status, you do
not have to give us that information. The failure to provide immigration information will not affect processing the application for the
remaining persons. However, any person who is applying for benefits for himself or herself has to provide information on their
immigration status.
Are all persons U.S. Citizens?	Yes	No

Complete the following for any non-citizens who are applying for benefits. If you need more room, attach another sheet of paper.

Name

Age

Arrival Date in the United States

Registration document/number

If there are persons who are not applying for SNAP and/or cash benefits because they do not wish to provide proof of their immigration status, please list them below. We will only ask questions about their income & assets.

Name (Last)	(First)	(MI)	Name (Last)	(First)	(MI)

1.			3.

2.			4.

General Household Questions


1. Are you or is anyone who lives with you blind?	Yes	No Disabled?	Yes	No
2. Does anyone in the household receive Social Security Disability or Railroad Retirement benefits? Yes					No
If yes, who:	What is their SSN or RRB claim number?

3.Does anyone have a physical, mental or emotional health condition that limits common activities (like bathing, dressing, daily chores, etc)? Yes No

If yes, who:

Does anyone applying live in a nursing home facility, supportive living facility, or other facility or institution?

Yes

If yes, who:

Name of facility:

bills from the last

Does anyone in your household want help paying for medical

3 months?

Yes

Has anyone in your household been in foster care at age 18 or older?

Yes

If yes, name of person:

Is anyone in your household age 18 or older a full time student? (college, or trade school)

Yes

If yes, name of person:

Language Preference

Does the adult member of your household who will discuss your case with IDHS speak English fluently?

Yes

If no, please list your preferred spoken language:

Does the adult member of your household who will usually receive mail or written information from IDHS read English fluently?

Yes

If no, please list your preferred written language:

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 2 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Household Composition

How many people live with you (include yourself)?

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Complete the following for everyone in the household. Include people who live with you who are not requesting assistance. You must give us the Social Security Number for each person for whom you are requesting benefits. You do not have to give us the number for any person for whom you are not requesting benefits, but if you do, it may speed up the application process.

Person 1

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

SELF

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Do you plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will you file jointly with a spouse?

Yes

If yes, list name(s):

Do you have any dependents?

Yes

If yes, list name(s):

Will you be claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How are you related to the tax filer?

The following two questions are optional. Answering these questions will not affect your eligibility or benefit amount. This information is to assure that program benefits are distributed without regard to race, color or national origin.

1.	Is this person Hispanic or Latino?	Yes	No
2.	What is your race? (Select one or more)

American Indian/Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Person 2

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Does this person plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will this person file jointly with a spouse?

Yes

If yes, list name(s):

Does this person have any dependents?

Yes

If yes, list name(s):

Is this person claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How is this person related to the tax filer?

The following two questions are optional. Answering these questions will not affect your eligibility or benefit amount.

This information is to assure that program benefits are distributed without regard to race, color or national origin.

Is this person Hispanic or Latino?

Yes

What is his/her race? (Select one or more)

American Indian/Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 3 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Household Composition (Continued)

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Person 3

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Does this person plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will this person file jointly with a spouse?

Yes

If yes, list name(s):

Does this person have any dependents?

Yes

If yes, list name(s):

Is this person claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How is this person related to the tax filer?

The following two questions are optional. Answering these questions will not affect your eligibility or benefit amount.

This information is to assure that program benefits are distributed without regard to race, color or national origin.

1.	Is this person Hispanic or Latino?		Yes	No
2.	What is his/her race? (Select one or more)
	American Indian/Alaskan Native	Asian	Black or African American		Native Hawaiian or Other Pacific Islander	White

Person 4

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Does this person plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will this person file jointly with a spouse?

Yes

If yes, list name(s):

Does this person have any dependents?

Yes

If yes, list name(s):

Is this person claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How is this person related to the tax filer?

The following two questions are optional. Answering these questions will not affect your eligibility or benefit amount.

This information is to assure that program benefits are distributed without regard to race, color or national origin.


1.	Is this person Hispanic or Latino?			Yes	No
1.	Is this person Hispanic or Latino?			Yes	No

2.	What is his/her race? (Select one or more)
	American Indian/Alaskan Native	Asian	Black or African American			Native Hawaiian or Other Pacific Islander	White

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 4 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Household Composition (Continued)

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Person 5

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Does this person plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will this person file jointly with a spouse?

Yes

If yes, list name(s):

Does this person have any dependents?

Yes

If yes, list name(s):

Is this person claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How is this person related to the tax filer?

1.	Is this person Hispanic or Latino?	Yes	No
2.	What is his/her race? (Select one or more)

American Indian/Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Person 6

Mark the box for the program this person is applying for:

SNAP

Medical

Cash

First

M.I.

Last

Suffix

Former Name, if any

Relationship to you

Social Security #

Gender

Birth Date

Marital Status

Pregnant? If yes, due date

How many babies expected?

If this person is applying for Medical assistance answer question 1.

1. Does this person plan to file a Federal Tax Return next year?

Yes

If yes, answer 2-4 below

Will this person file jointly with a spouse?

Yes

If yes, list name(s):

Does this person have any dependents?

Yes

If yes, list name(s):

Is this person claimed as a dependent on someone else's tax return?

Yes

If yes, list the name of the tax filer:

How is this person related to the tax filer?

1.	Is this person Hispanic or Latino?	Yes	No
2.	What is his/her race? (Select one or more)

American Indian/Alaskan Native	Asian	Black or African American	Native Hawaiian or Other Pacific Islander	White

If needed, please list extra household members on an additional piece of paper.

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 5 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

If you are applying for SNAP benefits complete this page.

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How much money do you or anyone who lives with you have in cash, checking, and/or savings? $

What is the monthly gross income (income of all sources before any deductions)
for you and everyone who lives with you?	$

How much money have you or anyone who lives with you received or expect to receive from any source in the month of application?

$When?Who:Source:

Shelter Costs

1. How much are you charged each month for your rent or mortgage? $

(For mortgage include property taxes and insurance.)
Do you share this expense with anyone?	Yes	No

2.	Did you receive a 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
3.	If No, are you billed separately from rent or mortgage for:
	NOTE: Air conditioning is a window air or central air conditioning unit.
	A. Heat or air conditioning?	Yes	No
	B. Excess cost for heat or air conditioning? Yes			No
	C. Does anyone outside of your SNAP household pay or help pay for your housing costs?						Yes	No
	D. Does anyone outside of your SNAP household pay your utility expenses?					Yes	No

If yes, please list the bills and the amounts paid:

Please complete the following information if you answered No, to question 2 or 3 and are not billed for heat or air conditioning separately

Expenses

Amount

How Often Due

Amount You Pay

Paid By Others

Electricity

Water and/or Sewerage

Garbage

Cooking Fuel

Basic Phone Service (including cell phone)

Septic Tank Installation Maintenance

Well Installation /Maintenance

A Fee for Starting Utility Service

A Flat Amount for Utilities

Explain:

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 6 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Migrant or Seasonal Farmworker Questions

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Is this a SNAP household of migrant or seasonal farm workers?			Yes	No
Did the household have income prior to the date of application?			Yes	No
If yes, did the income recently stop?	Yes	No If yes, date the income stopped?

Are liquid assets of household $100 or less AND does the household have a destitute migrant or seasonal farmworker?

Yes No

Are you or is anyone who lives with you expecting to receive more than $25 in income from a new source within the next 10

days? Yes No

Benefit Information

Has the primary applicant received SNAP benefits in any state in the month of application? Yes No Is the applicant a resident of a domestic violence shelter? Yes No

Medical Deduction for Persons Disabled or Age 60 or Older

If a SNAP household member is disabled or age 60 or older your SNAP household may be entitled to a Standard Medical Deduction. To get the Standard Medical Deduction, you have to prove you pay out of pocket monthly medical expenses of $36 or more.

*If you do not live in a group home the Standard Medical Deduction is $200. *If you live in a group home the Standard Medical Deduction is $485.

Can you prove that you pay $36 or more monthly in medical expenses?

Yes

If yes and you give us proof, we will allow the Standard Medical Deduction that applies to your household. If your monthly medical expenses that you pay are more than $200/$485 and you give us proof, we will allow your actual medical expenses.

Application Interview - Cash and SNAP

Please complete the following:

We will interview you within 14 days, or right away if you qualify for an expedited SNAP interview.

I am able to come to an office interview.

I must be interviewed by phone because:

I am applying for SNAP

And someone in my household is employed.

Problems with health, transportation, caring for a child or disabled adult, ongoing severe weather or educational activities conflict with work hours.

I am applying for cash assistance

Hours of work or educational activities conflict with office hours. Problems with health, transportation, caring for a child or disabled adult, ongoing severe weather or educational activities conflict with work hours.

I can be reached by phone Monday - Friday between 8:30 and 5:00 at:

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 7 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Income - Benefits - Expenses

Is anyone in your household currently employed?

Yes

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If yes, complete the following:

Name of Person:

Employer:

Employer Address:

Employer Phone:

Number of hours worked weekly:

Amount Paid (including tips) before taxes $

How often paid:

Weekly

Every two weeks

Twice a month

Monthly

Name of Person:

Employer:

Employer Address:

Employer Phone:

Number of hours worked weekly:

Amount Paid (including tips) before taxes $

How often paid:

Weekly

Every two weeks

Twice a month

Monthly

Is anyone in your household self-employed? Yes No If yes, name of person:

What kind of work do they do?

How much will they make this month, once they pay business expenses? $

Complete only if your income changes from month to month. If you don't expect changes, skip this section. What is the total income for each person for this year? If you anticipate a change, what will it be next year?

Person:	Total income this year:	$	Total income next year:	$

Person:	Total income this year:	$	Total income next year:	$

Person:	Total income this year:	$	Total income next year:	$

Does anyone named on this form RECEIVE money from any source other than employment (such as Social Security, educational

benefits, child support, spousal support, rental property, unemployment benefits, pensions, retirement, trusts)?

Yes

If yes, complete the following:

Name of Person:

Source:

Monthly Amount $

Name of Person:

Source:

Monthly Amount $

Name of Person:

Source:

Monthly Amount $

(Include additional pages, if needed.)

If this income is from rental property, is this person receiving the income also the property manager?

Yes

In the past year, has anyone in your household changed jobs, stopped working or started working fewer hours?

Yes

If yes, name of Person:

Does anyone in your household pay any of the following expenses?

Alimony paid: $

How often?

Weekly

Every two weeks

Twice a month

Monthly

Student loan interest: $

How often?

Weekly

Every two weeks

Twice a month

Monthly

Day-care: $

How often?

Weekly

Every two weeks

Twice a month

Monthly

Child Support paid : $

How often?

Weekly

Every two weeks

Twice a month

Monthly

Other deductions (Do not include any expenses you have already reported)

Type of expense:

How often?

Weekly

Every two weeks

Twice a month

Monthly

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 8 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

American Indian or Alaska Native Family Member (AI/AN)

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Are you or anyone in your family American Indian or Alaska Native (AI/AN)?	Yes	No
Are you or anyone in your household a member of a federally-recognized tribe?	Yes	No
If yes, tribe name:

If No, skip to next section.

Indian Health Services

List any family members who received services from the Indian Health Service, a tribal health program, or urban Indian health program. If nobody received these services, is anyone qualified to receive them?

List the names of anyone who received services:

List the names of anyone who qualifies for services:

Tribal Related Income

Does the income you listed on Page 7 include money from any of the following:	Yes	No
Payments from a tribe that come from natural resources, usage rights, leases or royalties?	Yes	No

If yes, amount: $

Payments from natural resources, farming, ranching, fishing, leases or royalties from land designated as Indian trust land by the
Department of the Interior (including reservations and former reservations)?				Yes	No
If yes, amount:	$

Money from selling things that have cultural significance?		Yes	No
If yes, amount:	$

SNAP and Cash Applicants:

Has any person been convicted in state or federal court of misrepresenting an address to receive assistance in two or more
states at the same time?	Yes	No
If yes, who

Is any person in violation of their parole or probation?			Yes	No
If yes, who

Is anyone fleeing from felony prosecution, an outstanding felony warrant or jail?					Yes	No
If yes, who

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 9 of 18
Printed by Authority of the State of Illinois	-0- Copies

State of Illinois

Department of Human Services

Request for Cash Assistance - Medical Assistance -

Supplemental Nutrition Assistance Program (SNAP)

Your Family's Health Coverage

Complete this page if you are applying for cash or medical benefits.	2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

Is anyone enrolled in health coverage now from any of the following? If YES, check the type of coverage and write their names next to the coverage they have.

Medicaid

CHIP

Medicare

Tricare (Don't check if you have Direct Care or a Line of Duty)

Veteran's Health Insurance Program

Peace Corps Health Insurance

Employer Insurance

Name of Insurance

Policy Number

Is this a retiree health plan?

Yes

Is this COBRA coverage?

Yes

Other

Is this a limited-benefit plan (such as a school accident policy)?

Yes

Is anyone listed on this application offered health coverage from a job?

Yes

Check YES even if the coverage is from someone else's job, such as a parent's or spouse's.

If YES, complete Page 11.

Tell us about the job that offers coverage:

Employer Name:

Employer Address:

Employer Phone Number:

Employer Identification Number (EIN):

Who can we contact about employee health coverage at this job?

Phone Number:

E-Mail address:

Can you get coverage now or sometime in the next 3 months?

Yes

If yes, when?:

List the name of anyone who can get coverage from this job:

IL444-2378B (R-09-21) Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program		Page 10 of 18
Printed by Authority of the State of Illinois	-0- Copies

Get Il444 2378 B PDF Form

Form Characteristics

Fact Name	Description
Form Title	The IL444 2378 B form is officially titled "Request for Cash Assistance - Medical Assistance - Supplemental Nutrition Assistance Program (SNAP)." This name reflects the primary purpose of the document.
Governing Law	This form is governed by the Illinois Department of Human Services rules and regulations related to cash assistance, medical assistance, and SNAP eligibility.
Filing Process	Applicants can file this form at their local Family Community Resource Center (FCRC) or by mailing it to the Central Scan Unit (CSU). The submission can be done in person or through the mail.
Eligibility Timing	Once the application is submitted, a decision regarding SNAP eligibility will be made within 30 days. If eligible, benefits are effective from the date of application.
Mandatory Signatures	To initiate the application process, the applicant must sign Page 1. Additionally, a signature on Page 18 is required prior to approving benefits.
Possible Immediate Benefits	Applicants may receive SNAP benefits immediately if they meet specific criteria such as low income or having minimal liquid assets.

Guidelines on Utilizing Il444 2378 B

After completing the IL444 2378 B form, you will submit it to the Illinois Department of Human Services (IDHS) for processing. This will initiate the evaluation of your eligibility for cash, medical assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits. You have several options for submitting your application, ensuring that it reaches the appropriate office in a timely manner.

Personal Information: Start by filling in your last name, first name, middle initial, and maiden name at the top of the form.
Contact Details: Provide your present address, including apartment number, city, state, zip code, and county.
Identification: Enter your birth date and Social Security number. Indicate if you are homeless by selecting "Yes" or "No."
Mailing Address: If different from the present address, fill in your mailing address, including city, state, zip code, and county.
Telephone Numbers: List your home, work, and other phone numbers, along with the best time to reach you.
Signature: Sign and date the form to initiate the application process. Remember to also sign Page 18 to finalize your application.
Approved Representative: If applicable, indicate if you want to name an approved representative by selecting "Yes" or "No." If yes, complete their name, address, and phone number.
Application Rights: Carefully read the information on pages 14-18 to understand your rights and responsibilities concerning the benefits for which you are applying.
Supplementary Information: Fill out the questions regarding citizenship or immigration status and household composition, providing details as required for each member of your household.
Submit the Form: Finally, print the form, review it for accuracy, and submit it in person at your local Family Community Resource Center (FCRC), or send it by mail to the Central Scan Unit.

What You Should Know About This Form

What is the IL444 2378 B form used for?

The IL444 2378 B form is a Request for Cash Assistance, Medical Assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits in the state of Illinois. Individuals complete this form to apply for necessary financial and medical support through the Illinois Department of Human Services (IDHS).

Who is eligible to apply using the IL444 2378 B form?

Eligibility primarily depends on the applicant’s income, household size, and specific assistance being sought (cash, medical, or SNAP benefits). Generally, residents of Illinois who meet the income and other criteria for these programs can apply using this form. It is especially designed for low-income individuals and families in need of financial and nutritional support.

How can I submit the IL444 2378 B form?

This form can be submitted by completing it either at home or in person at a local Family Community Resource Center (FCRC). If completed at home, you can mail the form or deliver it in person. Additionally, applications can also be made online via ABE.Illinois.gov or by calling the IDHS Helpline.

What information do I need to include when filling out the form?

Applicants must provide personal details such as their name, address, social security number, and date of birth. Information about household members is also required, including their names, ages, and relationship to the applicant. It is crucial to ensure all answers are clear and legible to facilitate the processing of the application.

What happens after I submit my application?

Once submitted, the application processing begins. If you are applying for SNAP benefits, you will receive a decision about your eligibility within 30 days. If eligible, benefits will be available starting from the date the application was filed. For other programs, additional processing times may vary.

Do I need to provide information about my immigration status?

If you are applying for benefits yourself, you need to provide your immigration status. However, if others in your household do not wish to disclose their status, they can still be included in the application without affecting the eligibility of the applicant. The application accommodates variations in immigration documentation and status.

Can I authorize someone to act on my behalf?

Yes, you can name an approved representative on this form. This person can sign your application, receive information related to your application, and act on your behalf with the agency. You will need to provide their information, including name and contact details, to officially designate them as your representative.

What if I need assistance while completing the form?

If you need help or have questions while filling out the IL444 2378 B form, you can contact your local FCRC. They provide the necessary resources and can assist with filling out the application. Additionally, the IDHS Helpline is available for further questions or concerns regarding the application process.

Are there any rights I should be aware of when applying?

Applicants have rights regarding the application process, including the right to file without discrimination based on race, color, or national origin. It is essential to read the information provided within the application, particularly pages outlining rights and responsibilities for different types of benefits, to ensure that you understand your entitlements and the obligations involved.

Common mistakes

Filling out the IL444 2378 B form requires attention to detail. Many individuals make common mistakes that can delay their application and affect their eligibility for benefits. Understanding these errors can help applicants navigate the process more effectively.

One prevalent mistake is failing to provide complete personal information. Many applicants neglect to fill out their full names, maiden names, or provide an accurate date of birth. Incomplete information can lead to confusion and delays in processing applications.

Another common issue occurs when people overlook the need for signatures. Applicants often forget to sign Page 1, which starts the application process, and Page 18, which is required for benefit approval. Without these signatures, applications remain unprocessed.

Misreporting household size is another frequent error. Some applicants either include or exclude household members incorrectly. It's essential to report everyone living in the household, regardless of whether they are applying for assistance. This ensures that the full context of the household situation is recognized.

Additionally, many individuals provide incorrect Social Security Numbers. This can happen either due to typos or misunderstanding of which numbers to provide. Each applicant needing benefits must provide their number accurately. Mismatched information can lead to verification issues.

Another mistake involves the section on citizenship and immigration status. Some people skip this part or fail to provide all required details for non-citizens. Although not required for all household members, all applicants must provide necessary information about their immigration status when applying for benefits.

Lastly, applicants may neglect to review their completed forms before submission. It is crucial to double-check all entries for accuracy. Errors or omissions that remain uncorrected can lead to significant delays or a denial of benefits. Taking the time to thoroughly review the application can make a significant difference in the outcome.

Documents used along the form

The IL444 2378 B form is crucial for individuals seeking assistance from the Illinois Department of Human Services. However, it is often accompanied by several other forms and documents that users should be aware of. Below is a list of these common documents, which may facilitate a smoother application process.

Illinois Voter Registration Application (SBE R-19): This optional form allows individuals to register to vote while applying for assistance. It can be submitted together with the IL444 2378 B to ensure that citizens can participate in elections.
Proof of Identity: Applicants may need to provide documents that verify their identity, such as a driver's license, state ID, or passport. This information helps confirm the applicant's identity for processing benefits.
Social Security Numbers for Household Members: It is essential to provide Social Security numbers for all individuals in the household applying for benefits. This documentation aids in determining eligibility for assistance.
Income Verification Documents: To assess financial need accurately, individuals must present proof of income. This could include pay stubs, tax returns, or bank statements, showing income sources and amounts.
Housing Information: Documentation regarding housing status, such as a recent lease agreement or mortgage statement, may be requested. This information helps determine eligibility for programs like SNAP based on living costs.
Medical Documentation: For those applying for medical assistance, providing medical records or documents proving the need for healthcare services is often necessary. This can include details of any disabilities or health conditions.
Application for Additional Programs: Depending on the individual's situation, they might be encouraged to apply for other assistance programs, such as the Low-Income Home Energy Assistance Program (LIHEAP). Completing these applications can provide additional help.

Gathering these forms and documents can expedite the processing of the IL444 2378 B application. Individuals seeking assistance must take action promptly to ensure that their applications are handled effectively and that they receive the assistance they need. Time is of the essence, and being well-prepared with the necessary documentation can significantly influence the outcome of the application process.

Similar forms

Form IL444-2378B (Request for Cash Assistance): Similar to the IL444-2378B, the application for Temporary Assistance for Needy Families (TANF) also requires personal details, household information, and signatures. Both forms serve to assess eligibility for financial support programs aimed at assisting low-income families in Illinois.
Form IL444-2378 (Application for Medical Assistance): This document shares similarities with the IL444-2378B form, as they both inquire about the applicant's medical needs and household details. They aim to verify eligibility for medical assistance programs and require similar personal information.
Supplemental Nutrition Assistance Program (SNAP) Application: The SNAP application form closely mirrors IL444-2378B, as both focus on food assistance eligibility. Each form prompts applicants to provide household income, expenses, and composition, ensuring accurate assessments for food support.
Illinois Voter Registration Application (SBE R-19): Incorporated within the IL444-2378B, this form allows applicants to register to vote while applying for assistance. Both documents require personal information and seek to facilitate participation in government programs.

Dos and Don'ts

Do: Print all of your answers clearly to ensure readability.
Do: Sign Page 1 of the application to begin the processing of your request.
Do: Provide your date of birth and Social Security Number on the signed page to expedite registration.
Do: Read the rights and responsibilities outlined on pages 14-18 before signing the application.
Don’t: Forget to sign Page 18 before your benefits can be approved.
Don’t: Leave any required fields blank; all necessary sections should be completed.
Don’t: Provide your immigration status unless applying for benefits; it’s not required for everyone.
Don’t: Submit the application to any location other than your local Family Community Resource Center or the Central Scan Unit.

Misconceptions

1. The IL444 2378 B form is only for low-income individuals. Many people think this form is strictly for those experiencing extreme financial hardship. However, it applies to a broader spectrum of applicants, including those just needing temporary assistance.

2. You cannot apply online. There is a misconception that the only way to submit the IL444 2378 B form is in person or via mail. In reality, it can also be completed online through the ABE website, making the process more accessible.

3. Signing the form means you automatically receive benefits. Many believe that merely completing the form guarantees approval for benefits. The signed form starts the application process but does not ensure approval. Eligibility is determined through a review process.

4. Each household member must provide proof of citizenship. While applicants need to provide information regarding their citizenship status, those who do not wish to disclose their status will not affect the application of other household members.

5. You cannot have someone help you complete the form. Some individuals think they must fill out the form entirely on their own. Actually, a family member or approved representative can assist with the completion and submission of the form.

6. You lose your benefits if you don’t apply immediately. This misconception leads many to rush their applications. While prompt applications can result in timely benefits, waiting a little longer does not mean you will lose eligibility.

7. There is a limit to the number of times you can apply. People often believe that there are restrictions on reapplying for assistance. In truth, individuals may reapply as necessary, especially if their financial situation changes.

8. All personal information is public. There is a concern that information on the form is publicly accessible. In reality, details provided on the IL444 2378 B form are kept confidential and protected under privacy laws.

9. I automatically qualify for SNAP if I receive medical assistance. Some may assume that receiving one type of assistance automatically qualifies them for another. Each program has its own eligibility criteria that need to be separately assessed.

10. You must notify the agency of income changes immediately. While it is important to report income changes, many people believe they will lose benefits immediately if they fail to notify the agency in an exact timeframe. Notifications should occur as soon as possible, but the impact on benefits varies depending on many factors.

Key takeaways

The IL444 2378 B form is used to request cash, medical, and Supplemental Nutrition Assistance Program (SNAP) benefits.
Print all answers clearly to ensure they are legible and understandable.
Completing and signing the top of Page 1 initiates the application process. Essential details include your name, address, and signature.
Filling out your birth date and Social Security Number on Page 1 expedites application registration.
Eligibility for SNAP benefits is determined within 30 days, with benefits issued from the filing date if approved.
Applicants may receive immediate SNAP benefits if their gross non-exempt income or assets are below specified limits.
Applications can be submitted online, by mail, or in person at local Family Community Resource Centers (FCRC). Include all household members’ information relevant to the benefits requested.
Completing the application does not require sharing immigration status for non-applicants, simplifying the process for all household members.

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