Skip to main content

Possible online services disruption due to Internet related outage

A worldwide technology outage is causing disruption to some State of Illinois online systems.  We are aware of this issue and are diligently working on restoration.

Certification Packet

The certification packet consists of the following documents.

NOTE: Each applicant must submit BOTH a Legal Entity Application and the appropriate Service Specific Application.

1. Legal Entity Application

Complete only one application per Adult Day Service, Automated Medication Dispenser, Emergency Home Response, and/or In-Home Service legal entity.

2. Service Specific Applications

Return your completed certification packet to:

NOTE: This is for EHRS and AMD only. Other applications are filed online.

Illinois Department on Aging
Attn: Office of Service Development and Procurement
One Natural Resources Way, Suite 100
Springfield, IL 62702-1271

*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.

We appreciate your interest in becoming a service provider under the Community Care Program!