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State of Illinois Department on AgingCommunity Care Program Provider Certification Application for INCOME SERVICE PSA 13 INSTRUCTIONS: Type N/A if question is not applicable. APPLICANT:PART A.PROPOSED
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Start by downloading the application form from the official website.
02
Carefully read the instructions provided with the form.
03
Fill out your personal details such as name, address, contact information, and any other required information.
04
Specify the type of in-home service you require and any specific instructions or preferences.
05
Provide any relevant medical or health information that may be necessary for the service providers to know.
06
If needed, attach any supporting documents or records that are required for the application.
07
Double-check all the information you have entered to ensure accuracy and completeness.
08
Sign and date the application form.
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Submit the completed form and any additional documents as per the submission instructions provided.

Who needs application for in-home service?

01
Anyone who requires in-home services can benefit from filling out the application form.
02
This includes individuals who are elderly, disabled, chronically ill, recovering from surgery or illness, or in need of assistance with daily activities.
03
The application form serves as a formal request for in-home service and helps service providers understand the specific needs of the individual seeking assistance.
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Application for in-home service is a form that individuals must fill out to request in-home services such as house cleaning, pet sitting, or childcare.
Anyone who wishes to receive in-home services must file an application for in-home service.
To fill out the application for in-home service, individuals must provide their personal information, the type of service needed, and any specific requests or requirements.
The purpose of the application for in-home service is to help service providers understand the needs and requirements of the individual requesting services.
Information such as contact details, service needed, specific requests, and any relevant information for the service provider must be reported on the application for in-home service.
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