Form hfs 1229a blank 2025

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The document is a renewal notice for Illinois Medicaid, informing the recipient about the process of redetermination for their medical coverage. It outlines steps to complete the renewal form, including providing accurate information, signing the form, and submitting necessary proof documents by February 25, 2014. The notice emphasizes the importance of timely submission to avoid loss of medical benefits and provides contact information for assistance.

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Click ‘Get Form’ to open the HFS 1229A in the editor.
Begin with Section A: Income. Indicate your income sources by checking 'Yes' or 'No' for each item listed, and provide the monthly amounts where applicable.
Proceed to Section B: Resources. Similar to Section A, check 'Yes' or 'No' for each resource type and fill in the values as required.
In Section C: Transfer of Resources, answer questions regarding any transfers made in the past year. Provide details about each transfer if applicable.
Complete Section D: Income Diversion by indicating if you are giving part of your income to family members and providing necessary details.
Finally, sign and date the form in Section E, ensuring all information is accurate before submission.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (62 Votes)
2012	1 Satisfied (16469 Votes)

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