Agency Contact PersonPhone Number Extension Ext ID: 844806
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1 Illinois Department of Human ServicesDiv
Illinois Department of Human ServicesDivisionof Developmental DisabilitiesCILA Individual HomeControl Request FormThis form is to be completed in accordance with the Department’s policy on determining Individual Control of CILA Homes. The Residential Provider Agency completes and forwards the CILA Individual HOmeControl Request to the Bureau of Accreditation, Licensure and Certification (BALC)This form may be submitted by fax to the BALCat (312)8144731, or mailed to DHS, BC, Agency Contact PersonPhone Number& Extension______________________________ _______________________________(_____) _____ ______________ Ext:______