This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form HFS2390 (IL478-1474)?
A: Form HFS2390 (IL478-1474) is the Abortion Payment Application used in Illinois.
Q: What is the purpose of Form HFS2390 (IL478-1474)?
A: The purpose of Form HFS2390 (IL478-1474) is to apply for payment for abortion services in Illinois.
Q: How do I obtain Form HFS2390 (IL478-1474)?
A: You can obtain Form HFS2390 (IL478-1474) by contacting your local Illinois Department of Human Services office.
Q: Who is eligible to use Form HFS2390 (IL478-1474)?
A: Any person who has received abortion services in Illinois may be eligible to use Form HFS2390 (IL478-1474) to apply for payment.
Q: What information is required on Form HFS2390 (IL478-1474)?
A: Form HFS2390 (IL478-1474) requires information such as the name and date of birth of the person receiving abortion services, the name of the provider, and the cost of the services.
Form Details:
Download a printable version of Form HFS2390 (IL478-1474) by clicking the link below or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.