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You may want to visit a local office to get help

filling out Form IL-1363.

Please call first before visiting.

150

There are over

Senior Health Assistance Program offices in Illinois where you can

get free help in filling out Form IL-1363 and answers to questions. To find an office near

you, you may contact the Illinois Department on Aging or one of the 13 local area agencies

on aging listed below.

Northwestern IL Area Agency on Aging

Area Agency on Aging of

Southwestern IL

Referrals for Boone, Carroll, DeKalb, JoDaviess, Lee,

Ogle, Stephenson, Whiteside, & Winnebago Counties

Referrals for Bond, Clinton, Madison,

Monroe, Randolph, St. Clair, &

2576 Charles Street

Washington Counties

Rockford 61108-1605

2365 Country Road

1 800 542-8402 (within area only) or 815 226-4901

Belleville 62221-2571

Northeastern IL Area Agency on Aging

1 800-326-3221 or 618 222-2561

Referrals for DuPage, Grundy, Kane, Kankakee,

Midland Area Agency on Aging

Kendall, Lake, McHenry, & Will Counties

Referrals for Clay, Effingham, Fayette, Jefferson, & Marion

Kankakee Community College

Counties

Riveroad West Campus Building 5

434 South Poplar Street

Kankakee 60901-0809

Centralia 62801-1420

1 800 528-2000 or 815 939-0727

1 877 532-1853 or 618 532-1853

Western IL Area Agency on Aging

Southeastern IL Area Agency on Aging, Inc.

Referrals for Bureau, Henderson, Henry, Knox,

Referrals for Crawford, Edwards, Hamilton, Jasper,

LaSalle, McDonough, Mercer, Putnam, Rock Island,

Lawrence, Richland, Wabash, Wayne, & White Counties

& Warren Counties

516 Market Street

729 34th Avenue

Mt. Carmel 62863-1558

Rock Island 61201-5950

1 800 635-8544 or 618 262-2306

1 800 322-1051 or 309 793-6800

Egyptian Area Agency on Aging, Inc.

Central IL Agency on Aging, Inc.

Referrals for Alexander, Franklin, Gallatin, Hardin,

Referrals for Fulton, Marshall, Peoria, Stark,

Jackson, Johnson, Massac, Perry, Pope, Pulaski, Saline,

Tazewell, & Woodford Counties

Union, & Williamson Counties

700 Hamilton Boulevard

200 East Plaza Drive

Peoria 61603-3617

Carterville 62918-1982

1 877 777-2422 or 309 674-2071

1 888 895-3306 (Southern Illinois only) or

East Central IL Area Agency on Aging, Inc.

618 985-8311

Referrals for Champaign, Clark, Coles, Cumberland,

Chicago Department on Aging

DeWitt, Douglas, Edgar, Ford, Iroquois, Livingston,

Macon, McLean, Moultrie, Piatt, Shelby, &

Referrals for Cook County-city of Chicago only

Vermilion Counties

30 North LaSalle Street, Suite 2320

1003 Maple Hill Road

Chicago 60602-2586

Bloomington 61704-9327

312 744-4016 or 312 744-6777 (TTY)

1 800 888-4456 (within area only) or

Disabled Chicago residents under 60

309 829-2065

Mayor’s Office for People with Disabilities

West Central IL Area Agency on Aging

2102 West Ogden Avenue

Referrals for Adams, Brown, Calhoun, Hancock,

Chicago 60612-4219

Pike, & Schuyler Counties

312 744-6673 or 312 744-7833 (TTY)

639 York

Suburban Area Agency on Aging

Quincy 62301-3000

Referrals for Suburban Cook County

1 800 252-9027 or 217 223-7904

1048 Lake Street, Suite 300

Project LIFE Area Agency on Aging, Inc.

Oak Park 60301-1054

Referrals for Cass, Christian, Greene, Jersey, Logan,

1 800 699-9043 (Suburban Cook County only) or

Macoupin, Mason, Menard, Montgomery, Morgan,

708 383-0258

Sangamon, & Scott Counties

2141 West White Oaks Drive, Suite C

Springfield 62704-6495

1 800 252-2918 or 217 787-9234

To contact the Illinois Department on Aging, see Page 20.

View the list of the local Senior Health Assistance Program offices at

Apply every year

Renew by March 31

IL-1363 instructions (R-12/04)

Form Il-1363 - Application For Circuit Breaker Grant, License Plate Discount, And Optional Help Paying For Drugs (Pharmaceutical Assistance Or Seniorcare) - 2004 Page 19

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