Fill in a Valid Il444 2378 B Template

The IL444 2378 B form is a document used by residents of Illinois to request cash assistance, medical assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits. Completing this form is essential for individuals seeking various forms of aid from the Illinois Department of Human Services. If you’re ready to start your application, click the button below to fill out the form.

Jump Links

The IL444 2378 B form is a vital document for individuals and families in Illinois seeking financial assistance through cash aid, medical assistance, and the Supplemental Nutrition Assistance Program (SNAP). This form serves as a comprehensive request for various forms of support, capturing essential information such as the applicant's name, birth date, social security number, and contact details. It also prompts applicants to address their living situations, including questions about homelessness, as well as their household composition, which is crucial for determining eligibility for benefits. Furthermore, the form includes sections for applicants to name an approved representative, ensuring that those who may need assistance can have someone act on their behalf. The instructions provided guide applicants through the completion process, emphasizing the importance of clarity and accuracy. Timeliness is also a key feature; applications for SNAP benefits can be administered swiftly within 30 days, giving applicants access to necessary resources when they are most in need. In this article, we will explore the details of the IL444 2378 B form, offering guidance on its completion and the rights and responsibilities associated with seeking assistance in Illinois.

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:

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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)?

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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)

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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)

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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.

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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

					2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c
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

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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)

2aabfaa2-d3e7-47d2-8547-1ab9b3cfbd4c

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

Click for Il444 2378 B File

File Breakdown

Fact Name	Fact Details
Purpose	The IL444 2378 B form is a request for cash assistance, medical assistance, and the Supplemental Nutrition Assistance Program (SNAP) in Illinois.
Eligibility Decision Timeline	For SNAP benefits, eligibility decisions will be made within 30 days from the date of filing the application.
Signature Requirement	Applicants must sign Page 1 of the form to start the application process and Page 18 before receiving any benefits.
Illinois Governing Laws	Application processing is governed by the Illinois Administrative Code and Federal-law amendments regarding public aid assistance.
Filing Locations	The completed form can be submitted at local Family Community Resource Centers, or mailed to the Central Scan Unit in Springfield, IL.

Guide to Using Il444 2378 B

Once you have gathered all necessary information, it’s time to complete the IL444 2378 B form. Make sure each section is filled out carefully to avoid any delays in processing your application for benefits.

Begin by entering your Last Name, First Name, Middle Initial, and Maiden Name in the designated fields.
Fill in your Present Address, including the Apartment Number, City, State, Zip Code, and County.
Provide your Birth Date and Social Security Number.
Indicate whether you are homeless by checking the appropriate box.
If your mailing address is different from your present address, enter that information, including the City, State, Zip Code, and County.
List your telephone numbers: home, work, and other contacts, including your daytime phone and the best time to call you.
Sign the form to start your application. Remember, you must also sign Page 18 before benefits can be approved.
If you wish to name an approved representative, indicate Yes and provide their name, address, phone number, and organization name, if applicable.
Complete the section regarding Citizenship/Immigration Status to confirm if all applicants are U.S. Citizens.
Answer general household questions about disabilities, Social Security, and living situations.
List the household composition, including the names, relationships, and Social Security Numbers of all individuals in your household.
Make sure all information is printed clearly and legibly to facilitate processing.

Once the form is completed, double-check for accuracy before submitting it either in person to your local Family Community Resource Center (FCRC) or by mailing it to the Central Scan Unit (CSU). This step is essential because any errors can delay your application process. Now, act quickly to ensure your submission meets any deadlines that may apply.

Get Answers on Il444 2378 B

What is the IL444 2378 B form used for?

The IL444 2378 B form is a request for various types of aid provided by the Illinois Department of Human Services (DHS), including Cash Assistance, Medical Assistance, and Supplemental Nutrition Assistance Program (SNAP) benefits. This application allows individuals or families in need to apply for assistance that can help alleviate financial burdens related to essential needs such as food, healthcare, and daily living expenses.
Who is eligible to apply for benefits using this form?

Eligibility depends on various factors, including income level, household size, and residency status. Generally, individuals or families facing financial hardship, those who meet specific income thresholds, and citizens or qualified non-citizens can apply. It is recommended to review the eligibility requirements for each type of assistance offered by DHS for more specific details.
How do I complete the IL444 2378 B form?

To complete the form, applicants should carefully print their answers in the designated spaces. Essential personal information, such as name, address, social security number, and details about household members, must be included. It’s crucial to follow the instructions provided in the application to ensure clarity and facilitate processing.
What happens after I submit the IL444 2378 B form?

Upon submission, the Illinois Department of Human Services will review the application. For SNAP benefits, applicants can expect a decision within 30 days after filing. If eligible, benefits may be issued retroactively to the date of application. It's important to follow up with the local Family Community Resource Center (FCRC) if there are concerns regarding the status of the application.
Can someone else fill out the form for me?

Yes, another member of the household or an adult who knows you can complete the form on your behalf. However, that individual must provide accurate answers for those they are applying for, not for themselves. The applicant must ensure that the person filling out the form is familiar with the household's circumstances.
What is an approved representative, and how do I designate one?

An approved representative is a person you authorize to act on your behalf regarding your application. This may include signing the application, receiving official information, and managing correspondence with the DHS. To designate someone as your approved representative, you must provide their name, address, and phone number on the application form.
What if I don’t want to provide my immigration status?

If you or anyone else in your household does not wish to disclose immigration status, that information is not mandatory. However, any individual applying for benefits themselves must provide their immigration status. The absence of this information will not hinder assistance for other eligible household members.
Do I have to sign Page 18 of the application?

Yes, signing Page 18 is required before any benefits can be approved. This signature signifies that you understand and agree to the terms outlined regarding your application and the responsibilities tied to receiving assistance.
How can I file the IL444 2378 B form?

You can complete the IL444 2378 B form at home and submit it to your local Family Community Resource Center (FCRC), either in person or by mail. Alternatively, applications can be submitted online through the ABE (Application for Benefits Eligibility) portal or via phone by contacting the DHS Helpline.
What should I do if I need help with the application process?

If assistance is needed, you may contact the Illinois Department of Human Services Helpline at 1-800-843-6154. They can provide guidance, clarify questions about the application, and direct you to your nearest Family Community Resource Center for further support.

Common mistakes

Filling out the IL444 2378 B form can be a straightforward process, but several common mistakes may hinder your application. By avoiding these errors, you can ensure a smoother experience while applying for Cash, Medical, and SNAP benefits.

One major mistake is failing to provide complete and accurate information about your household. It's essential to list all individuals living in the home, including those not applying for assistance. Each person's Social Security number must also be included if they are part of the application. Omitting details may cause delays or even denial of your application.

Another error involves neglecting to sign the appropriate pages. Your signature is crucial to validate the application. Specifically, page one must be signed at the time of submission, and page eighteen must be signed before approval for benefits. If signatures are missing, the application cannot be processed, and you must start over.

Some applicants mistakenly overlook the importance of accurate contact information. Providing correct phone numbers and addresses is vital. This allows the Illinois Department of Human Services (IDHS) to reach you efficiently. If any of your contact details change after submission, notify the IDHS immediately to prevent miscommunication.

Failing to read and understand your rights and responsibilities can also be problematic. The instructions in pages fourteen and fifteen outline your obligations regarding SNAP benefits. Being unaware of these requirements could lead to complications or misunderstandings during your application process.

Lastly, many applicants miss the opportunity for expedited benefits by not reporting urgent financial circumstances. If your income or assets meet specific criteria for immediate assistance, you must provide that information clearly. Ignoring this could result in unnecessary waiting times for benefits that you might qualify to receive sooner.

Documents used along the form

The IL444 2378 B form is often accompanied by several other documents and forms when applying for assistance programs in Illinois. Here are some commonly used forms that may be relevant to your application process.

Application for Benefits Eligibility (ABE) Form: This online application form allows you to apply for various state benefits, including Cash, Medical, and SNAP. It simplifies the process and can be submitted digitally.
Voter Registration Application (SBE R-19): This optional form can be included with your benefits application to register to vote. Filling it out does not affect your benefits.
Supplemental Nutrition Assistance Program (SNAP) Client Identification Form: This form is used to gather necessary information about individuals applying for SNAP benefits, including household members and their financial details.
Medical Assistance Application Form: Specifically for individuals seeking healthcare benefits, this form assesses eligibility for medical assistance and provides necessary health-related questions.
Social Security Number Verification Form: This document is needed to confirm Social Security numbers for all applicants. Verification helps streamline the benefits approval process.
Income Verification Statement: You may be required to provide documentation or a statement verifying your household income. This helps determine benefit levels based on your financial situation.

Reviewing these forms can help you prepare the necessary documentation while applying for benefits through the Illinois Department of Human Services. Make sure to gather all required information to facilitate a smooth application process.

Similar forms

Form 1040 (U.S. Individual Income Tax Return) - Similar in that both forms require personal identification information such as name, social security number, and address for the applicant. Each form facilitates the determination of eligibility for benefits, whether financial or tax-related, depending on the applicant's income and household information.
Food Stamp Application Form - This form is specifically targeted towards individuals applying for food assistance. Like the IL444 2378 B, it gathers extensive household income and composition information to evaluate eligibility for nutritional support.
Medicaid Application Form - Similar to the IL444 2378 B, this document is used to request medical assistance. Both forms require details on household members and their respective income and insurance status to determine eligibility for health benefits.
Supplemental Security Income (SSI) Application - This form also collects personal identification and household details. The information is utilized to assess eligibility for cash benefits based on disability and income requirements.
Welfare Application Form - Like the IL444 2378 B, this form aims to obtain financial aid for specific needs. It requires similar data regarding household income and family composition to ascertain eligibility for government assistance.
Unemployment Benefits Application - This application gathers personal data and employment history. Both it and the IL444 2378 B evaluate financial circumstances to determine eligibility for monetary support from the government.
Child Care Assistance Application - This form requires details about the child's care needs and household income. Similar to the IL444 2378 B, it assesses the financial situation of a family unit to provide assistance related to child care costs.
Veterans Affairs Benefits Application - This form requires personal identification and information on service history. Like the IL444 2378 B, it seeks to understand the applicant's circumstances to determine eligibility for benefits and support services available to veterans.

Dos and Don'ts

Do's:

Print all answers clearly to ensure they are legible.
Complete the top of Page 1 with your name, address, and signature to begin the application process.
Review pages 14-18 to understand your rights and responsibilities related to SNAP and cash benefits.
Provide your date of birth and Social Security Number where required to help with registration.
Sign page 18 before submitting the application to be eligible for benefits.
File the application at your local Family Community Resource Center (FCRC) or via mail.

Don'ts:

Do not skip signatures or required sections; missing information can delay your application.
Do not provide inaccurate information, as it may lead to disqualification from benefits.
Avoid submitting the form without reviewing it for completeness and accuracy.
Do not forget to inform about your immigration status for those applying for benefits, if applicable.
Do not hesitate to ask for help if you are unsure about how to fill out any part of the form.
Do not ignore the option to register to vote, though it is optional and won't affect your benefits.

Misconceptions

Misconception 1: You need to provide your immigration status for all household members.

Many people believe that if one member of the household must disclose their immigration status, everyone else does too. In reality, you only need to provide immigration information for those applying for benefits. If other household members are not applying, their immigration status is not required.
Misconception 2: The application can only be filled out by the person applying.

Some assume that only the applicant can complete the form. However, another household member or an adult who knows the applicant can also fill out and submit the application. This flexibility helps ensure that everyone who needs assistance can get it.
Misconception 3: You have to wait a long time to start receiving benefits.

Many believe that applying for benefits means waiting indefinitely. But if you qualify for SNAP benefits, a decision will be made within 30 days. In some cases, you may even receive benefits earlier if you meet specific criteria.
Misconception 4: All information provided will be shared with other agencies.

Concerns about privacy are common, but the information you provide on the IL444 2378 B form is used solely for the assessment of benefits. It's crucial that applicants know their information is protected and will not be shared indiscriminately.
Misconception 5: Signing the application means you are automatically approved.

Some applicants think that merely signing the application ensures automatic approval for benefits. This is not accurate. You must complete all necessary information and meet eligibility requirements, including signing specific pages before benefits can be issued.

Key takeaways

The IL444 2378 B form is crucial for applying for cash, medical, and Supplemental Nutrition Assistance Program (SNAP) benefits in Illinois.
Complete the application with accurate personal information, including names, addresses, dates of birth, and Social Security numbers.
Sign page 18 to formally submit the application; benefits cannot be approved without this signature.
Submitting page 1 initiates the application process and sets the timeline for review.
Read the rights and responsibilities sections on pages 14 to 18 carefully; understanding these is essential for eligibility.
Snap eligibility decisions will be made within 30 days, and benefits can be backdated to the application date if approved.
Consider an approved representative if someone will assist you; complete their details in the appropriate section.
Use the IDHS Office Locator to find your nearest Family Community Resource Center for in-person applications.
Apply online anytime at ABE.illinois.gov or by calling the IDHS Helpline for further assistance.

Fill in a Valid Il444 2378 B Template

Il444 2378 B Example

File Breakdown

Guide to Using Il444 2378 B

Get Answers on Il444 2378 B

What is the IL444 2378 B form used for?

Who is eligible to apply for benefits using this form?

How do I complete the IL444 2378 B form?

What happens after I submit the IL444 2378 B form?

Can someone else fill out the form for me?

What is an approved representative, and how do I designate one?

What if I don’t want to provide my immigration status?

Do I have to sign Page 18 of the application?

How can I file the IL444 2378 B form?

What should I do if I need help with the application process?

Common mistakes

Documents used along the form

Similar forms

Dos and Don'ts

Misconceptions

Key takeaways