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FOR BHF USELL1 2020STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2020) I.DPH License ID Number: Facility

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Individuals who are applying for home care services for the aged in 2020.

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What is new-aformns-home-for-form-aged-0033043?

This form is used to report information regarding home for the aged.

Who is required to file new-aformns-home-for-form-aged-0033043?

Administers or owners of homes for the aged are required to file this form.

How to fill out new-aformns-home-for-form-aged-0033043?

The form must be filled out with information regarding the operations and residents of the home for the aged.

What is the purpose of new-aformns-home-for-form-aged-0033043?

The purpose of this form is to ensure proper reporting and oversight of homes for the aged.

What information must be reported on new-aformns-home-for-form-aged-0033043?

Information regarding the number of residents, staff, and operations of the home for the aged must be reported.

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