Get Form Name (form Number) - Illinois Department Of Human Services - Dhs State Il

This guide provides a detailed overview of how to fill out the Individual Provider Standards form (IL488-2112) for the Illinois Department of Human Services. Follow these comprehensive steps to ensure that your form is completed accurately and submitted successfully.

Follow the steps to complete the Individual Provider Standards form online.

1. Click ‘Get Form’ button to access the Individual Provider Standards form and open it for editing.
2. Begin by filling in the name of the Individual Provider in the designated field.
3. Indicate the gender of the Individual Provider by selecting either 'Male' or 'Female' in the provided options.
4. Enter the birthdate of the Individual Provider in the format MM/DD/YYYY.
5. Provide the phone number of the Individual Provider, including the area code.
6. Fill in the legal address where the Individual Provider resides.
7. Add the mailing address for where the Individual Provider will receive payments.
8. Select the appropriate age category for the Individual Provider from the options available.
9. Choose the preferred payment option for the Individual Provider from the listed choices.
10. If applicable, indicate whether the Individual Provider has provided the necessary documentation for their position.
11. Complete the section regarding any incidental health care tasks to be performed by the Individual Provider.
12. Affirm that the Individual Provider has demonstrated an understanding of Universal Precautions.
13. Confirm that the Individual Provider has provided the required documentation, including their Social Security card.
14. Indicate whether the Individual Provider has completed the Employment Eligibility Verification form (I-9).
15. Certify that the information you have provided is true and accurate, and sign the form as required.
16. Once all sections are completed, save any changes to the form, and you can then download, print, or share it as needed.

Complete the Individual Provider Standards form online today to ensure timely processing of services.