State of Illinois Department of Human Services I - dhs state il 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part A: General Information. Fill in the Date Completed, Provider Name, and Taxpayer Identification Number. Ensure all contact details, including phone numbers and addresses, are accurate.
3. Move to Part B: Legislative Districts. Enter the relevant IL Senate, IL House, and U.S. Congressional district information.
4. In Part C: Relationships With Other Entities, list any public funding boards you have received funding from along with their types.
5. Complete Part D: Warrant Mailing Information if payments are to be sent to a different address than your provider location.
6. Proceed to Section II for Satellite Information. Repeat similar steps as above for filling out the satellite details.
7. Continue through Sections III and IV by providing Program Information and Residence Information respectively, ensuring all fields are filled accurately.

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