Contact Phone or Email ZXk+CgkJCTxzdHJpbmc+Y29tLmFwcGxlLmpvYnRpY2tldDwvc3RyaW5nPgoJCQk8a2V5PmNvbS5h G9bWc6ui7Hh3cnCNRpibmWEsklckzvK3BmMNILyVkgGDg+eSU4cKBVVT639CpVLJs/8AYF9bDY6P OGxoopmaqS0ynbfJ1QlhRi9e8NFuxs9n+ManykVNhBTSWYE4oXkEwRoBYF/HhiP07lNiFXZ2FV/s s8SSFFN9+kAynkSGWOIxInFckNMUKRGA9wm7q4KDtiDdUsV1v1anDHeJ0IoCG008ySVxFLcLvdtQ Beware of scams. xsbGuc3Zoa42QUcfIXFyQJTCSEIADGrNGErGM5H6czWdaVs6+dUnSDGt1LFh8aKlmysokN+PMHos gCJLz6ixgWITIN1tJOxGk4Zb29fSffTdApvCJKtlu0URoBNbkeq2PV/KHhrWt4Lvok5JsxEz257a a2V5PgoJCQkJPGludGVnZXI+MDwvaW50ZWdlcj4KCQkJPC9kaWN0PgoJCTwvYXJyYXk+Cgk8L2Rp RJwJgvrS5UxKFlPXvXSmKyJNjDy1lt7vH5zBXxmfUpYfcEnKNLyLGfT0FjPOJ79tbX066tze79ce zAod0adcnya0PIEgFLbg8QREmFDGVywGH95fXrrZV9iVBsttTDM35oxCYBXWyaGNwiTxpNLLUaEJ Z64tjdqt0unWEWBr5M6kmsMbd+NIrKpIFeZsfTm8XOQnETuo2CWo3Ba4TwSJxUoJi3MxphxJEXVL oS2z2r7Dahtr0zOBeMKEakH+VskDC4Bx8lkkrAuCBSgXEZCcmUFhEHP/ADjOGydwLcPpT3Jayyrc JocRl0iju9fYg9XM4bDdp+0uj+70LsaXILE0Xq2F1rGYJTkMjrybG4E+QSO2FHX91tOvZQ3txSw2 hAUYWcHERNnet3XXYXuvt2Gyt/2HreWbIaTRK7Y9PdfrJlFOooFZlPzgyvP3R2FG1qVtsCaujatQ MLq9OJcZfk60slC0GJ0wsnKA5CV0d0XyhJcGnuxPTjuZWtt1yTEm6xY7RMM2ThB9Y2dbGlNmLZMj y3JpIASCtbXmjyZNy6zQtqhWsaoMmj5ZjOmco+vwowlcVx+TnE0gIBgzgwv0Hna3Q+n/ALzUFCaT 2xXyqgI3UgTe24anRsJTuM0iMXOyElS7ngNdsgJCpNLFkasd2u4moPXP3jbEJr+6vewqAUf2U0qw izrwoFJsFGqD6uIw7VfZVzEXVeUEueyY+1T+eXDP1S1xMmyKrksYtqNNBcdRshQl6NU6titiVHAS LwIZpxxo8BCHGM5znPpzY+6ud761WH1CdKNYU8z7DXNSyxJtfb1QWBOHZdVyLdy6Gd9k9RoLMJJC KbFqCWODYo2+1xg8WjxzqqeqxsN8c2xNesQZ8pRjNa3gRTshbSs5LUKMl5Fyqrcbs76vNla/h3a9 eiudhsx7T6oONXRkWPfXl5NVnq1Npxc6z7N1H9F+ixfT6hb6n6bK5bqNWZX0u3pnW7bLunNpqZb1 xnZXUX1fsnGa3MyH4/qh7/QazfjXOux7GM9a/ZT9m+1+vk4/6Za+RWHtudY3q1rsktstw666gzfX MSIgdGlmZjpYUmVzb2x1dGlvbj0iMzAwMDAwMC8xMDAwMCIgdGlmZjpZUmVzb2x1dGlvbj0iMzAw E9X8BASrAskSgJSYgfuDGao8Cw5yPxzHnUfrR6YtstHaR3JTaCUbEma0aRaLSeEJjOriRLC5Esgz Ix7vSobj2022AbHenZ6Tm3etuY2l9foe/KyP5qj9H6mHX6WW8VvS3Y3TIvY+pnq+l1HdtIml9LcZ More than 50,000 home care workers are united in SEIU Healthcare Illinois & Indiana. 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I understand falsification of any information submitted on this form could lead to criminal prosecution. 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WOaUTI2OqZ5EyLVCp4TGHoctSJWAQhqSxDKySHIw5yH0zmdHZNo9X2hlqVzVMH2kqzaZfIahis7n AAABAAAlggEAOEJJTQQeAAAAAAAEAAAAADhCSU0EGgAAAAADTwAAAAYAAAAAAAAAAAAAAdAAAAHQ NmFZZk/zm3f6n2TJysltFNlV2dXg2Yn82sNpbdmZPULH5OQ+t9zL8yCL6DXjvuqxG+o7Fv6bVYxv jEui7lIGiblib8kmObYoyrIz7hYADDkXT2rukm+lq2MVb/Wlbu0/UfpTHMShHF6O3LxLr3kdvWGB l2t2tEu2GYEg6wgbpYjwsIldZYkreoQkEuLGhCjQHnp8ZUE5BkReei3ennQvX2V9ie5sx1b7D6wo QiEo9l0b/bNyXkf+UQOd+YK7idJmFG3NaOC9rlZNa13Roz1z3HNeNuG6P4SIsRk6Qr3gZFPWYvTr ZQgbm+YNzeSNHk03PuoVpZuQgGHIAUedJFA0XbHdFuHMj2iPVzUvWtZWwFz1IgV4Rglhzhe0ofGf gymOjILKreo/WC3K+0VtvryOn2+hjdOb6/6L0vR/TVfarFs9AxnXfXW/1Q0u6D0rEwHe4vAuuH2l WZPSX30491DfQrxWZVO/f/OM9TIv9Ku5RysqqzGd1HpPSm4NX1a6oG47biLKouh2Wx11dt1dTcfK 7TYBz9RZANQIn+nJLy77dnbueZRSMLbTsDPhRcfd5yWgqbGVexDeLPpgySglpz3mOtMlQ/8AA4uB lP3aatiu8mpHXP2DijqtVTF6V3I9atiUYZN+MRV3V+7ETZoufMUmSDz2UhxrW9Y0ymgcVywKVMSR of Human Services, 400 W. Lawrence Street, P.O. It shows training information for certified nursing assistants (CNA) and other health care workers. zBhPn0M7u3I699/LWqeq9rq73HufafZClKcjb4kp1zS69axw1nira4xmw7ioTYQdTvMVm85ZbVRR 7JT/AJLc8ZSCTuCM5YoVHJ7p9CMWh3wddtJbZXi0zHTnc+rJFIIvUe21TJWxqXWO2MBiMp6fBQt2 01+/I+z+p69lLN/Y1PUep0Ybvtl2fk2XNxei1HJzNrxXlehd1Ut+yY1H2zCZk+hi4uZk4P8AgMj+ H6pW1iyzob66iWubTh2xXRU5z68uu/Hfj02Ws9DPx6stlFjbqP0mX/NfaP0aU4Ut6j1LqXUcfEPU ru4HCDlp3Ntb5AoanhvJZrNLj5OWicx8paBJKo2uPPJLMF7QhQju7uKpbcDXFrkMNiU1fu9bRCUP iQ0mw9lq5DJ8yibbL34XIlshfkT+5jSp0MUJclZz0lbPdOOGT7wCsacuOOOOOOOOOf/W38cccccc wjTkSh4VMTM2/wC2KzaGQw/yWDe2rBSEQDAGm+hfuC0nU7sLRewcaaZjR1u13a8afWlO+tTrBJaz The Persons with Disabilities (PD) waiverprovides services and individualized support to persons with a disability who live in the home. /H2prlajoJvG/E7BFOjDD7JmVLkMTO7lRgMtizUmwhwqdEsdCE9QPJQTchBrNYdClkX7R5t2GNFg DjPOMRj7EMejs7lEV2k0C2+12i0NLJFKbbaGiNbA1lHADdW5sOdHp/plfIBkRcoLoUdl0IKUJQAw HnzvA/pEX3XKYqZ2B7+7Qb8U/B3BukLDrtZaCAV3UTzK2tYUrQvdksdas7SOxSUeS/8AEkWCLJAL WsfUOli+3VIuDAskdflWda7ZjYOC1wN3XltcVRzuaQx5afiLjBIilJmcg8sCTZ9rOpWkudaHdZU2 UdYPXn9dLSWwYPRu9vZvsHfFk1U3vjFP4LUcdkT5XcXczFLis/USD4TGrAUQTDM8PxioaIlZk9So The Illinois Department of Human Services Division of Rehabilitation Services (DHS-DRS) is the Operating Agency (OA). yIJAcCzj7v19i3/bLa7tK7xZ3E5FICJK/S6vtfWfLcaneXiJxhrE7uCCLrCymVhcFQo0xM7L45RB /jIa3jrdB3JXlMkIMTmhUH4LICJQZjy1Ed19wQGn5/VPWFqhVzIg1v0/iVOSYvWmtj0MdS3PvFeU XkgoZYj/AEByLG21D39sfuvpv2F6k7XXzrJrn3c1VGqms+UNsXlVvRyqrZfoAphDdTlkwx7d2COv oyEipsWKa/TuJ+DwmnHrFJ4jBi8v4oa6vtPdgu//ALQnewNlZDMZdE1j7i2NqLaTowkJUcfawJ08 lcVK6UOoXynlqdoaCEbSrENUZjBeAJjf7egBenS0C2J3L/QILsZcHWT173TR9jRuLyqqjtU7pbXa usDXlISAYMDgsbcoMCULBuBhFjSJN9qov3J/Xc2If9QHKdV9OoHTwohJICQ9s+Z0xSak0DFIHKLO I understand falsification of any information submitted on this form could lead to criminal prosecution.Customer Signature:Date:Date of customer signaturedate{MMM D, YYYY}------------------------------------------------------------FOR OFFICE USE ONLY---------------------------------------------------------DHS Payment Approval:authorizationDate:date{MM/DD/YYYY}Auth.