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State of Illinois Department of Healthcare and Family Services 1. Identifying Information Provider Name ENROLLMENT DISCLOSURE STATEMENT ILLINOIS MEDICAL ASSISTANCE PROGRAM DBA Name Provider No. NPI
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How to fill out form HFS 1513?

Begin by carefully reading the instructions provided with the form. The instructions will guide you on the specific information to be filled in each section of the form.
Start with the personal information section. This usually includes your name, address, contact details, and any other relevant identification information.
Move on to the purpose section. Here, you will state the reason for filling out the form HFS 1513. Make sure to provide concise and accurate information.
Proceed to the relevant sections of the form that pertain to your specific situation. These sections may include details about your income, expenses, assets, liabilities, or any other information required by the form.
Double-check each entry before moving on to the next section. Ensure that all information provided is accurate and up-to-date.
If there are any sections that you are unsure about or that require additional documentation, seek guidance from the relevant authority or contact person indicated in the form or instructions.
Once you have completed all the necessary sections, review the entire form to ensure that you have not missed any required information.
Finally, sign and date the form where indicated, and follow any additional submission instructions provided.

Who needs form HFS 1513?

Individuals who are applying for financial or social assistance programs may need to fill out form HFS 1513. This form is often required to assess eligibility and determine the level of assistance that the individual may be entitled to.
The form may also be needed by individuals or organizations involved in providing services or resources to those in need. They may require this form as part of their documentation process to ensure the proper allocation of resources or the provision of appropriate assistance.
It is advisable to check with the specific organization, agency, or program you are dealing with to confirm if form HFS 1513 is indeed required in your particular situation.

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