Get Il Il462-4424 2014-2026

The IL IL462-4424 form is essential for individuals requesting additional staff support or for 1 or 2 person Community Integrated Living Arrangements (CILA) with 24-hour staffing. This guide provides a clear, step-by-step approach to accurately fill out the form online.

Follow the steps to complete the IL IL462-4424 form online.

1. Click the ‘Get Form’ button to access the IL IL462-4424 form and open it in the editor.
2. Begin by filling out the individual’s name, Social Security Number (SSN), and their Registration Identification Number (RIN) in the appropriate fields.
3. Enter the requesting agency’s name, along with the agency's Federal Employer Identification Number (FEIN) and Agency ID.
4. Indicate the date of the request in the designated field.
5. In section 2, check the appropriate box to indicate whether this request is for 60D CILA Residential or 31U Developmental Training. Note that if these are different provider agencies, separate request forms are necessary.
6. For section 3, check the relevant box to specify whether this is an initial additional staff support request, a long-term request, or a renewal/review. Fill in the date and time of when the staff supports were implemented if applicable.
7. In section 4, indicate whether this is a request for emergency support, an application for 60D CILA, or a renewal for a 1 or 2 person CILA with 24-hour shift staff by selecting the appropriate box.
8. Complete fields for the pre-award letter if applicable, including the date the pre-award letter was granted.
9. Print the name of the requesting executive director or designee and provide their email address.
10. Obtain the signature of the requesting executive director or designee, and note the date sent to the receiving ISC agency along with the print name and email address of the receiving ICS Agency.
11. Review all the entered information for completeness and correctness before finalizing the form.
12. Once all fields are filled accurately, save your changes, download, print, or share the completed form as necessary.

Start filling out your IL IL462-4424 form online today for a smooth application process.