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FOR BHF USELL1
2012
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2012)I.DPH License ID Number:
Facility
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What is completing form ldss 3114?
Completing form ldss 3114 is a document used to report information related to social services benefits.
Who is required to file completing form ldss 3114?
Individuals receiving social services benefits are required to file completing form ldss 3114.
How to fill out completing form ldss 3114?
Completing form ldss 3114 can be filled out by providing accurate information about income, assets, and household members.
What is the purpose of completing form ldss 3114?
The purpose of completing form ldss 3114 is to assess eligibility for social services benefits.
What information must be reported on completing form ldss 3114?
Information such as income, assets, and household composition must be reported on completing form ldss 3114.
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