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State identity proofing request form - DHS 2026
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- Click ‘Get Form’ to open the State Identity Proofing Request Form in the editor.
- Begin by entering your ABE Username, First Name, Last Name, Date of Birth, Phone Number, and Email Address in the designated fields. Ensure all required fields marked with an asterisk (*) are completed.
- Fill in your Mailing Address. If this address differs from what is on file with the State, indicate whether you want to update it by selecting 'Yes' or 'No'.
- Provide either your Social Security Number or Case/Application Number as instructed. Remember that only one of these is necessary.
- Answer the questions regarding Medicaid services and representation accurately. If applicable, ensure you attach a signed Approved Representative form.
- Review your entries for accuracy and completeness before signing and dating the form at the bottom.
- Once completed, download or print the form and return it to the Illinois Department of Human Services as specified.
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