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Application Download

  1. English HBWD Application (pdf)

  2. Solicitud de HBWD en español (pdf)

Application Request

  1. HBWD Application Request

For more information or to request an application to be mailed, please call our hotline Toll-Free at:


TTY: 1-866-675-8440

The HBWD Application is available for download in Portable Document Format (PDF). You will need Adobe Acrobat Reader® to view or print these files.

If Acrobat Reader is not already installed on your computer, click on the icon below for a free Download. Then follow the instructions to install the program.



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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director

We improve lives.