Instructions And Benefits Information For Form Il-1363 - Illinois Department Of Revenue - 2002 Page 3
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20Second, if you qualify, you will receive a SeniorCare
prescription card and form that you must complete
and return to us. On this form, you must cancel your
SeniorCare prescription coverage and tell us about
any other insurance you have that helps you pay for
prescription drugs.
Questions about who qualifies
What if I am married?
Who qualifies as disabled?
If you are married and you and your spouse lived
To qualify as disabled, you must be at least
together during 2002, you must complete one
16 years of age and
Form IL-1363 and report your total combined
receive disability benefits from one of the
income. Your spouse cannot apply separately.
following:
If one or both of you live in a nursing home, you
1 Social Security Administration, or
should each complete separate Forms IL-1363.
2 Veterans Administration, or
If you and your spouse were permanently
3 Civil Service, or
separated in 2002 and are still living at different
4 Railroad Retirement,
addresses, you may each complete separate
or have one of the following:
Forms IL-1363.
5 a Class 2 disability card from the Illinois
If my spouse died before applying, do I
Secretary of State’s office, or
qualify?
6 a completed Schedule A, Doctor’s
If your spouse died in 2002 or 2003 before
Statement, for each person who does not
sending us a properly completed 2002
have proof of disability listed above.
Form IL-1363, you may qualify. You must meet
Use a separate Schedule A for each person.
the requirements listed under “Who should
You must attach proof of disability
apply?” on Page 2.
— see Page 17.
You must complete Form IL-1363 in your own
name. Be sure to read the instructions for Line 7
What if I become 65 years old in 2003?
to determine the correct box to check for your
You may apply for
situation.
a partial grant based on the number of
You must include the amount of income your
months you were 65 years of age in 2003,
spouse received during the months your spouse
(we issue grants after you turn 65); and
was living with you in 2002.
prescription coverage. If you wish to receive
You must attach proof of your age
coverage as soon as possible after you turn
— see Page 17.
65, you should apply at least three months
before your birthday.
If you were 63 or 64 years of age before the
death of your spouse (if your spouse was
Who is a qualified additional resident?
receiving or was eligible to receive program
A qualified additional resident is an individual,
benefits),
other than your spouse,
you must also attach proof of
who lived with you in the same residence in
death — see Page 17.
2002 and in 2003 at the time you file your
2002 Form IL-1363; and
What if I share my home with
for whom you, or you and your spouse,
someone other than my spouse or
provided more than half of that person’s
any qualified additional resident?
total financial support in 2002; and
A person who lives with you (other than your
who is not filing a separate
spouse or qualified additional resident) may
2002 Form IL-1363.
apply on a separate Form IL-1363, if he or she
You must attach proof of your qualified
meets the requirements listed under “Who
additional resident (Schedule B) — see
should apply?” on Page 2.
Page 17.
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Avoid a delay
Apply by March 31
IL-1363 instructions (R-12/02)
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