PDF-State of Illinois Department of Human ServicesRequest for Cash Assista

Name Last First MI Name Last First MI1324Page 2 of 18Language PreferenceDoes th. The entire Act may be found in the Illinois Compiled Statutes Chapter 625 at the following link httpwwwilgagovlegislationilcsilcs3aspActID 1826ChapterID49 More co mplete information is available from Department of Natural Resources Law Enforcement brPage 1br State of Illinois Illinois Department of Public Health brPage 2br State of Illinois Illinois Department of Public Health brPage 1br State of Illinois Illinois Department of Public Health brPage 2br brPage 1br State of Illinois Illinois Department of Public Health brPage 2br State of Illinois Illinois Department of Public Health brPage 1br State of Illinois Illinois Department of Public Health 123 SPECIFIC LEVEL OF FUNCTIONING ASSESSMENTAND PHYSICAL HEALTH INVENTORY IL462-1215 (R-9-08) (formerly DMHDD - 1215) Page 2 of 6 Instructions: Check the number that best describes this person's typical And. Interagency Committee on . Employees with Disabilities. DHR and ICED and State Jobs. Human Rights Act Coverage. Covers Employers (w/1 employee), State Agencies, Employment Agencies, Labor Organizations . HFS 3082 (R-12-11) DOB: Nine-Digit HFS Recipient #: Name: Fax: NPI #: Phone:Prescriber information (required): Phone: Fax: NPI #: Pharmacy Name:Pharmacy information (required only when : Phone: Fax James T. Dimas. , Secretary. State Opioid Response – Hospital Screening and Warm Handoff. Notice of Funding Opportunity – Bidder’s Conference Webinar. October 18, 2018. Agenda for the Webinar. Review Presentation. Publicatio n 118 December 2009 Tire User Fee The information in this publication is current as of the date of the publication. Please visit our website at tax.illinois.gov to verify you have the V117x0000x00002 V11 17Table of ContentsSubject Page NumberIntroduction11Overview and Purpose12RequirementsAccessNOSAProcessingx0000x00003 V11 17IntroductionOverviewand PurposeThe Grantee Portal was de SPECIFIC LEVEL OF FUNCTIONING ASSESSMENTAND PHYSICAL HEALTH INVENTORYIL462-1215 R-9-08 formerly DMHDD - 1215Page 2 of 6Instructions Check the number that best describes this persons typical level of Illinois State PoliceScotts LawPrinted by the Authority of the State of IllinoisISP Central Printing SectionISP 1-163 6/175MPrinted on Recycled PaperwwwillinoisgovwwwispstateilusThe MOVE OVER LawPleas Family Size 3 Monthly Income Monthly Co-Pay $0 - 1,919$1.00 1,920 - 2,11120.00 2,112 - 2,303 44.00 2,304 - 2,495 72.00 2,496 - 2,687104.00 2,688 - 2,879 139.00 2,880 - 3,071 179.00 3,072 - 3,263 222.