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Get IL IL444-3415 2011-2024

Llowing information to the Illinois Department of Human Services. understand that this information may be verified by phone. Any fraudulent, false or misleading information given may result in loss of childcare payments and my child care case may be cancelled or denied. Client Signature Date Client Case Number JOB INFORMATION: TO BE COMPLETED BY YOUR EMPLOYER ONLY. Start Date: Employee Name: Rate of Hourly Pay: Pay Period: Weekly: Is the employee paid cash? If on leave: Employee Job Title:.

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