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Online Forms
Online Forms
The following forms are available for online review, completion, or submittal to HFS. The title and description of each form is provided below for your convenience. Please include information in all required fields in order to ensure accurate and timely handling of your request or submittal.
| Form Number | Form Name | Description | Link to Form |
| Hardship Waiver Application (English) | Request for waiver from estate recovery due to hardship | (pdf) |
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| Hardship Waiver Application (Spanish) | Request for waiver from estate recovery due to hardship | (pdf) |
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| Hardship Waiver Application (Polish) | Request for waiver from estate recovery due to hardship | (pdf) |
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| Hardship Waiver Application (Chinese) | Request for waiver from estate recovery due to hardship | (pdf) |
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| Hardship Waiver Application (Tagalog) | Request for waiver from estate recovery due to hardship | (pdf) |
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| Hardship Waiver Application (Arabic) | Request for waiver from estate recovery due to hardship | (pdf) |
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Trauma Letter | Generated when we show HFS paid for medical expenses related to an injury or illness | (pdf) |
| Nursing Home Small Estate Affidavit | Legal document requiring the addressee to release available funds to HFS | (pdf) |
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| IL444-0103 | Appeal Request Form | Completed when appeal is requested via the Department of Human Services (DHS) | (pdf) |
| IL444-2878 |
Request to Withdraw Appeal |
Completed when appeal submission is withdrawn by requestor | (pdf) |
| HFS 3419C | Payment Affidavit | Remittance Advice to Accompany Payment Submission | (pdf) |