The certification packet consists of the following documents. NOTE: Each applicant must submit BOTH a Legal Entity Application and the appropriate Service Specific Application.
Legal Entity Application
Complete only one application per Adult Day Service, Automated Medication Dispenser, Emergency Home Response, and/or In-Home Service legal entity.
Service Specific Applications
Adult Day Service
A separate application must be submitted for each Adult Day Service site
Automated Medication Dispenser (AMD) Service
Emergency Home Response Service
All forms must be completed accurately before processing can be started. Any incomplete packet will be returned. Be sure to maintain a copy for your records.
Return your completed certification packet to:
Illinois Department on Aging
Attn: Office of Service Development and Procurement
One Natural Resources Way, Suite 100
Springfield, IL 62702-1271
We appreciate your interest in becoming a service provider under the Community Care Program!