Loading
Get Il 1363 Form 2020-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Il 1363 Form online
Filling out the Il 1363 Form online can be a straightforward process if you follow the right steps. This guide provides clear, step-by-step instructions to ensure that you accurately complete the application for Illinois Cares Rx, which assists with prescription drug costs.
Follow the steps to successfully complete your Il 1363 Form online.
- Click the 'Get Form' button to obtain the form and open it in the editor.
- Begin with Step 1: Claimant Information. Enter your Social Security number, full name including first, middle initial, and last name, and your complete address, including apartment number, city, state, and ZIP code. Indicate your gender and citizenship status by checking the appropriate boxes.
- In Step 1, respond to questions regarding your Medicare status, HIV/AIDS status, and if you would like to receive a monthly rebate. Answer these questions truthfully as they determine your eligibility for benefits.
- Move on to Step 2 for your spouse’s information, if applicable. Similarly, complete the spouse’s Social Security number, name, birth date, and provide answers regarding their Medicare status and eligibility for benefits related to prescription costs.
- Proceed to Step 3 where you will indicate your or your spouse's ownership of assets, such as bank accounts and other investments. This step is important for determining eligibility.
- In Step 4, if you have a Qualified Additional Resident (QAR), fill in their information including Social Security number and name, and complete the questions regarding their benefits.
- After acknowledging the conditions in Step 5, sign the form. Ensure that all signatures are dated accurately.
- Finally, in Step 6, mail the completed application to the specified address. Make sure to keep copies for your records.
Complete your Il 1363 Form online today to take advantage of available benefits!
To qualify for the circuit breaker in Illinois, you must meet age, income, and property ownership criteria. Generally, homeowners aged 65 and older, as well as some individuals with disabilities, may qualify if their income is below a defined threshold. Be sure to fill out the IL 1363 Form to confirm your eligibility before applying.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.