Section 135.40  Application process

a)         A parent/guardian residing in the State of Illinois may obtain an application packet via a telephone call or letter to the ICG Program Office at:

            ICG Program Office

            Department of Human Services

            Office of Mental Health

            160 North LaSalle, 10^th Floor

            Chicago IL  60601

            Telephone:  312/814-4288

b)         Complete application materials containing information about the ICG/MI program, the eligibility criteria, required forms and instructions will be sent to the parent/guardian.  The cover sheet/application check list will refer the parent/guardian to the SASS agency that will be available to assist the parent/guardian, if requested.

c)         An ICG/MI application is complete and ready for eligibility determination review when it contains the following required documents:

1)         Completed application package checklist (DMHDD-230);

2)         Completed application form (DMHDD-231);

3)         Completed DMHDD-403c, Financial Questionnaire;

4)         Copy of the child's birth certificate;

5)         Copy of the child's Social Security card;

6)         Copy of the court order defining custody or non-parental guardianship, if appropriate;

7)         Psychiatric evaluation dated within 90 days before the current application submission including mental status examination, a specific principal diagnosis and all other diagnoses, medications, treatment summary and recommendations;

8)         A written summary of all trials of less restrictive treatment within the past 12 months;

9)         Psychological evaluation dated within the past one and one-half years, describing both intellectual and personality functioning;

10)         Social and developmental history from early childhood to present;

11)         Proof that a child is enrolled in an approved educational program at the elementary/high school level; and

12)         Parent/guardian request for eligibility determination and verification of review by parent/guardian of the clinical information submitted (DMHDD-232).

d)         Incomplete application packages will be returned to the parent/guardian without review for eligibility determination, indicating missing or incomplete, vague, ambiguous, or illegible items.

(Source:  Amended at 23 Ill. Reg. 1628, effective January 25, 1999)