Form HFS2390 (IL478-1474) Abortion Payment Application - Illinois

Form HFS2390 (IL478-1474) Abortion Payment Application - Illinois

What Is Form HFS2390 (IL478-1474)?

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.

FAQ

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.

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Form Details:

  • Released on November 1, 2005;
  • The latest edition provided by the Illinois Department of Healthcare and Family Services;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form HFS2390 (IL478-1474) by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.

Download Form HFS2390 (IL478-1474) Abortion Payment Application - Illinois

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