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The HFS 1513 form is an Enrollment Disclosure Statement used primarily within the Illinois Medical Assistance Program. This document is critical for ensuring transparency regarding an entity’s ownership and operational structure. A DBA, or "Doing Business As," name refers to the trade name a business operates under, which may differ from its legal name.
Including a DBA name in the HFS 1513 form ensures clarity and accountability for entities participating in state programs, such as those providing medical assistance. Accurate disclosure of DBA names helps avoid administrative errors and potential legal issues.
Locate the Specific Section: Find the section designated for DBA information on the form. This is typically clearly labeled.
Accurate Disclosure: Enter the DBA name exactly as registered. Ensure there are no discrepancies to avoid processing delays or compliance issues.
Associated Details: Provide any required associated details that may be requested on the form, such as business addresses or registration numbers.
A registered company named "Healthcare Enterprises LLC" operating under the name "Sunnyvale Medical Services" would need to list "Sunnyvale Medical Services" as their DBA in the relevant section of the HFS 1513 form.
Download or Obtain: Obtain the latest version of the HFS 1513 form from the Illinois Department of Healthcare and Family Services.
Complete the DBA Section: Clearly fill in the DBA name in the specified area, checking for any specific instructions provided within the form guidelines.
Review: Double-check all entered information for accuracy to avoid non-compliance issues.
Submit: Follow submission instructions, which may include digital entry or mailing the completed form to the appropriate address.
Ensuring the information provided in sections pertaining to DBA and ownership are accurate and truthful can safeguard businesses from potential legal repercussions.


Entities looking to enroll or maintain enrollment in state programs that require a high level of transparency and accountability.
Providing false or misleading information can result in penalties, including fines or disqualification from participation in state programs.
The form is primarily used for programs within Illinois, and adherence to specific Illinois state regulations is required.
Case 1: A healthcare provider discovered discrepancies in their DBA name on various documents, leading to form rejection. Accurate verification and re-submission resolved the issue.
Case 2: A new applicant successfully enrolled in a state program by following explicit guidance for DBA documentation, streamlining their application process.
In sum, the HFS 1513 form is a vital tool for businesses operating under a DBA to ensure compliance, transparency, and effective participation in state programs. Proper attention to detail when completing this form can significantly impact its acceptance and the company’s eligibility to provide services under state assistance programs.
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