Get Il Cc 92.3 2016-2026

This guide provides step-by-step instructions for completing the IL CC 92.3, an application for death benefits pursuant to the Line of Duty Compensation Act. Following this guide will help ensure that all required information is filled out accurately and submitted properly.

Follow the steps to successfully complete the IL CC 92.3 form online.

1. Press the ‘Get Form’ button to obtain the IL CC 92.3 form and open it in the online editor.
2. Fill in the name of the decedent in the designated field clearly.
3. Provide the address of the decedent's Illinois residence at the time of death.
4. If applicable, include the address where the decedent entered the U.S. Armed Forces.
5. Specify the place of birth of the decedent.
6. Enter the date of death in the required format.
7. Complete the field for the date of injury resulting in the decedent's death, if applicable.
8. If the decedent was an Armed Forces member, indicate the branch of service.
9. For those not in the Armed Forces, list the decedent's employer and their address.
10. Fill out the rank and title of the decedent at the time of death or injury.
11. Provide names and addresses of all beneficiaries as indicated in the Line of Duty Compensation Act Designation of Beneficiary Form.
12. Attach a copy of the Line of Duty Designation of Beneficiary form.
13. For claims involving Armed Forces members, attach relevant Department of Defense documents if available.
14. If the decedent left a will, attach a copy and provide details for each beneficiary.
15. Complete the marital status of the decedent at the time of death.
16. If applicable, provide the name, address, and phone number of the surviving spouse.
17. Indicate whether the decedent had children and provide their details if applicable.
18. Fill out the information for other parents of any children listed.
19. For those without surviving spouses or children, provide details of surviving parents or next-of-kin.
20. Attach any necessary documents that explain the circumstances of the decedent's death.
21. Fill in the applicant's information including name, address, relationship to the decedent, and date of application.
22. Sign the application form to certify correctness.
23. Return the completed application, signed, along with all attachments to the specified address.
24. Finally, save your changes, and choose to download, print, or share the form as needed.

Complete your application for death benefits online today to ensure timely processing.