Il request 2026

1. Click ‘Get Form’ to open the State Identity Proofing Request Form in the editor.
2. Begin by entering your ABE Username, First Name, Last Name, Date of Birth, Phone Number, and Email Address in the designated fields.
3. Fill in your Mailing Address. If this address differs from what is on file with the State, indicate whether you want it updated by selecting 'Yes' or 'No'.
4. Provide either your Social Security Number or Case/Application Number as required. Ensure that all asterisked (*) fields are completed.
5. Answer the questions regarding Medicaid services and representation accurately. If applicable, attach a signed Approved Representative form.
6. Review your entries for accuracy and completeness before signing and dating the form at the bottom.
7. Attach a copy of acceptable identity proofing documentation as specified in the instructions and submit the form via mail or fax.

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