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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
  • The Cook Central Office, 36 South Wabash Avenue, Chicago, will close 02/03/2025.  The new Cook Central Office will open at 115 South LaSalle, Chicago, for in-person service on 02/10/2025.  
  • ​UPDATE: The State Disbursement Unit (SDU) is processing all payments received. To verify the status of your payment, please log into the SDU parent portal or contact the SDU Customer Service Call Center at 877.225.7077.  For SDU business hours, click here.
Elizabeth M. Whitehorn, Director

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)
  Hardship Waiver Application (Spanish) Request for waiver from estate recovery due to hardship (pdf)
  Hardship Waiver Application (Polish) Request for waiver from estate recovery due to hardship (pdf)
  Hardship Waiver Application (Chinese) Request for waiver from estate recovery due to hardship (pdf)
  Hardship Waiver Application (Tagalog) Request for waiver from estate recovery due to hardship (pdf)
  Hardship Waiver Application (Arabic) Request for waiver from estate recovery due to hardship (pdf)
 
 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)
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 Completed when appeal submission is withdrawn by requestor (pdf)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)