Get Il Ucia Consent Form
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How to fill out the IL UCIA Consent Form online
The IL UCIA Consent Form is essential for individuals seeking certification as Navigators or In-Person Counselors, as mandated by Senate Bill 1194. This guide will provide you with a step-by-step approach to successfully complete the form online, ensuring all necessary information is accurately captured.
Follow the steps to fill out the IL UCIA Consent Form online.
- Press the ‘Get Form’ button to access the IL UCIA Consent Form and open it in your preferred editor.
- Complete the Facility Information section by entering the Facility Name, the Requesting Agency ORI Identifier (Illinois Department of Insurance IL920702Z), and the Requesting Agency Address including City, State, and Zip.
- In the Contact Name field, provide the name of the person you can reach out to at the facility, along with their Contact Email.
- Fill out the Applicant Information section with your Name, Sex, Race, and Date of Birth. Also, enter your complete Applicant Address, City, and Zip, along with your Phone Number and optional Social Security Number.
- Record your Applicant Email Address and Drivers License Number. If applicable, enter the Name of your Employer and their Address, including State and Zip.
- Provide the details of the Employer Contact Person including their Name, City, State, and Zip.
- In the Live Scan Vendor/Appointment Information section, enter the Live Scan Fingerprint Vendor Name, Address, Phone Number, Appointment Date, and Appointment Time.
- Read the Privacy Statement carefully. In the Applicant Consent section, print your name, sign, and date the form to authorize the release of criminal history record information.
- Once all fields are accurately completed, save your changes, and choose to download, print, or share the completed form as needed.
Take the next step and complete the IL UCIA Consent Form online today.
Filling out a consent form for biometric data involves providing necessary personal information, indicating your agreement to data collection, and understanding how your data will be used. Ensure you read all instructions carefully before signing. For a seamless process, you can refer to templates available on platforms like uslegalforms, which provide guidance on completing the IL UCIA Consent Form and other necessary documents.
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