Form hfs 1229a blank 2026

The document is a notice from the Illinois Department of Healthcare and Family Services regarding the renewal of medical coverage for Medicaid recipients. It outlines the steps required for redetermination, including completing a form, providing proof of income and expenses, and submitting the information by a specified deadline. 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. Answer all questions regarding your income sources, such as Social Security and pensions. Input the monthly amounts where required.
Proceed to Section B: Resources. Indicate whether you possess any resources like cash or savings accounts, and provide their values.
In Section C: Transfer of Resources, disclose any transfers made in the past year. Fill in details about each transfer, including descriptions and values.
Complete Section D: Income Diversion by indicating if you are giving part of your income to family members. Provide necessary details if applicable.
Finally, sign and date the Customer Statement in Section E, ensuring all information is accurate before submission.

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