Providing Proof of Benefits Received to Customers

(FCRC) Complete Form 3711 in its entirety and with the most recent information for any customer requesting verification of their benefits.

When a customer asks for verification of their benefits, find out from the customer the names of all persons who should be included on Proof of Receipt of Program Benefits (Form 3711). Use the Integrated Eligibility System (IES) to verify eligibility for each individual. Do not give copies of IES screens to the customer to use as their proof of benefits.

Complete Proof of Receipt of Program Benefits (Form 3711) in the following sections : Full name of the person; Enter (Yes) or (No) for the applicable program the person is receiving. Do not leave blank; and The current benefit receipt month; and Date benefit is approved; and Date benefit ends (or must be renewed).

The IDHS employee completing the form should sign and complete the name and address in the FCRC section. Affix the Family Community Resource Center stamp to the form.

Upload a copy of the Form 3711 to the customer's electronic case file in IES.

Providing accurate information on Form 3711 is important as some customers may qualify for additional services with another agency or governmental department, if they can show proof that they are eligible for a DHS program or service.

Example: A customer who is applying for a fee waiver from the Department of Homeland Security - U. S. Citizenship and Immigration Services (USCIS) may be eligible for a waiver of fees related to various applications and petitions processed by USCIS. The waiver is requested using USCIS Form I-912.