IL HFS 2378H 2003 free printable template
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DPA 2378H R-1-03 For more information call 1-800-252-8635 for persons using TTY 1-800-447-6404. IL478-1685 Instructions 1 INSTRUCTIONS Read the application carefully and follow all instructions. Illinois Department of Human Services Mail-In Application for Medical Benefits Esta solicitud est disponible en espa ol. This application is available in Spanish. Assets and Income of Spouse - Provide proof of a spouse s assets and income if anyone applyi...
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How to fill out IL HFS 2378H
How to fill out IL HFS 2378H
01
Obtain the IL HFS 2378H form from the appropriate Illinois Health and Family Services website or office.
02
Enter the personal information such as your name, address, and contact details at the top of the form.
03
Fill out the sections related to household members, including their names, dates of birth, and relationship to you.
04
Provide income information for all household members, including wages, benefits, and any other sources of income.
05
Indicate any relevant health insurance coverage or medical expenses in the appropriate section.
06
Review all entered information for accuracy and completeness.
07
Sign and date the form at the designated area.
08
Submit the completed form according to the instructions provided, either online or by mail.
Who needs IL HFS 2378H?
01
Individuals or families in Illinois applying for healthcare benefits through the Illinois Health and Family Services.
02
Those seeking assistance with Medicaid or other state-funded health programs.
03
Anyone required to report income or household information for eligibility determination.
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What is the 800 number for Illinois DHS?
You may also write the Department of Human Services (IDHS) at Department of Human Services, Bureau of Civil Affairs, 401 South Clinton St., 6th Floor, Chicago, Illinois, 60607 or call the IDHS Helpline Number at 1-800-843-6154 or 866-324-5553 TTY/Nextalk or 711 Relay.
What does Department of Human Services do in Illinois?
Illinois created DHS in 1997, to provide our state's residents with streamlined access to integrated services, especially those who are striving to move from welfare to work and economic independence, and others who face multiple challenges to self-sufficiency.
How do I check the status of my SNAP in Illinois?
If you submitted an online application, you can Check Your Status online. If you mailed your application or supporting documentation contact the SNAP Retailer Service Center at 1-877-823-4369 to find out the status of your application.
What does the Illinois Department of Healthcare and Family Services do?
We work together to help Illinoisans access high quality health care and fulfill child support obligations to advance their physical, mental, and financial well-being. COVID testing and vaccines are free in Illinois - get yours today.
What does Illinois DHS stand for?
IllinoisDepartment of Human Services.
What does Illinois DHS do?
Providing equitable access to social/human services, supports, programs and resources to enhance the lives of all who we serve.
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What is IL HFS 2378H?
IL HFS 2378H is a form used by the Illinois Department of Healthcare and Family Services to gather information related to health and social services for specific programs.
Who is required to file IL HFS 2378H?
Individuals and organizations that are involved in providing health and social services and receive funding from the Illinois Department of Healthcare and Family Services are required to file IL HFS 2378H.
How to fill out IL HFS 2378H?
To fill out IL HFS 2378H, you need to provide accurate and complete information as requested on the form, including details about the services provided, funding, and any other relevant data.
What is the purpose of IL HFS 2378H?
The purpose of IL HFS 2378H is to collect necessary data to ensure compliance with state and federal regulations and to assess the effectiveness of health and social service programs in Illinois.
What information must be reported on IL HFS 2378H?
IL HFS 2378H requires reporting on the types of services provided, patient demographics, funding sources, and outcomes of the services delivered.
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