Form CFS490-16 "Determination Notice" - Illinois

What Is Form CFS490-16?

This is a legal form that was released by the Illinois Department of Children 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.

Form Details:

  • Released on June 1, 2015;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS490-16 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS490-16 "Determination Notice" - Illinois

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CFS 490-16
6/2015
State of Illinois
Department of Children and Family Services
DETERMINATION NOTICE
CHILD’S NAME (Last, First, M.I.)
AKA
DATE OF BIRTH
CHILD’S ID NUMBER
SOCIAL SECURITY NUMBER
CASEMANAGER’S NAME
RE/ST/FD
Have not yet received
ELIGIBILITY DECISION
TITLE IV-E
FOSTER CARE
ADOPTION SUBSIDY
REASON FOR INELIGIBILITY
ELIGIBLE
NOT IN CARE
INELIGIBLE
BENEFITS
SSI
SSA
NO DEPRIVATION OR SPEC REL
CLOSURE
None
INCOME/RESOURCES EXCEED MAXIMUM
MANG CODE
NO REPP FINDING
OVER 18 – NOT IN SCHOOL OR WORKING
COMMENTS:
BACKGROUND CHECK ISSUES
OTHER
DATE FORM COMPLETED
ICPC.Cobra@illinois.gov
CFS 490-16
6/2015
State of Illinois
Department of Children and Family Services
DETERMINATION NOTICE
CHILD’S NAME (Last, First, M.I.)
AKA
DATE OF BIRTH
CHILD’S ID NUMBER
SOCIAL SECURITY NUMBER
CASEMANAGER’S NAME
RE/ST/FD
Have not yet received
ELIGIBILITY DECISION
TITLE IV-E
FOSTER CARE
ADOPTION SUBSIDY
REASON FOR INELIGIBILITY
ELIGIBLE
NOT IN CARE
INELIGIBLE
BENEFITS
SSI
SSA
NO DEPRIVATION OR SPEC REL
CLOSURE
None
INCOME/RESOURCES EXCEED MAXIMUM
MANG CODE
NO REPP FINDING
OVER 18 – NOT IN SCHOOL OR WORKING
COMMENTS:
BACKGROUND CHECK ISSUES
OTHER
DATE FORM COMPLETED
ICPC.Cobra@illinois.gov