Get Il Dhs Lifeline Eligibility Verification System Data Sharing Agreement 2018-2025

This guide provides clear and practical instructions on how to complete the IL DHS Lifeline Eligibility Verification System Data Sharing Agreement online. Whether you are familiar with digital forms or navigating them for the first time, this step-by-step process will support you throughout.

Follow the steps to accurately complete the form:

1. Click ‘Get Form’ button to obtain the form and open it in a suitable editing platform.
2. Fill in the Vendor's name in the space provided at the beginning of the document, ensuring accuracy.
3. Provide the principal place of business address for the Vendor in the designated area, as it is vital for identification.
4. In Article I, confirm your understanding of the background and purpose of this agreement and acknowledge the responsibilities defined within.
5. Complete the User Information Request Form as indicated in Article II to receive your logon identifier and password.
6. Utilize the logon ID and password to submit verification inquiries as outlined in Article III. You will need to input the following fields: First Name, Last Name, Last four digits of Social Security Number, and Date of Birth.
7. Review the data privacy commitments in Article IV to ensure confidentiality guidelines are adhered to.
8. Complete the sections regarding access permissions and user job titles as detailed in Article III and Exhibit B.
9. Ensure all necessary signatures and titles are filled in at the end of the agreement, both for the Vendor and the Illinois Department of Human Services.
10. Once all fields are completed and verified for accuracy, save changes to the document, and choose to download, print, or share the form as needed.

Take the next step to complete your documentation online!