Illinois Administrative Code (Last Updated: March 27, 2024) |
TITLE53. INTERGOVERNMENTAL RELATIONS |
PART100. PROCEDURES |
§100.EXHIBIT B. Response of State Agency
-
I.
Background Information
A.
Name of Respondent:
Principal office address:
Telephone: (Area Code)
B.
Name Respondent's Representative:
Title
Office Address
Telephone: (Area Code)
Check the allegations of the appeal petition which you dispute:
Respective Paragraph
Not
of Appeal Petition
Disputed
Disputed
I C
II A
II B
II C
II D 1
II D 2
II D 3
II D 3 a
II D 3 a(1)
II D 3 a(2)
II D 3 a(3)
II D 3 a(4)
II D 3 a(4) (a)
II D 3 a(4) (b)
II D 3 a(4) (C)
II D 4
II D 4 a
II D 4 a(1)
II D 4 a(1) (b)
II D 4 a(1) (b) (1)
II D 4 a(1) (b) (2)
II D 4 a(1) (b) (3)
II D 4 a(1) (b) (4)
II D 4 a(1) (b) (5)
II D 5
II D 5 a
II D 5 b
II D 5 c
II D 5 d
II D 5 e
II D 5 f
II D 5 g
II D 5 h
II D 5 i
II D 5 j
II D 5 k
III A
III B
III C
III C(1)
III C(2)
III D
III D(1)
III D(2)
III D(3)
III D(3) (a)
III D(3) (b)
III D(3) (b) (i)
III D(4)
III D(5)
III D(6)
III E
III E(1)
III F
III F(1)
III F(2)
III G
III G(1)
III G(2)
III H
III H(1)
III H(2)
III H(3)
III I
III J
III J(1)
III K
For each disputed allegation, explain in detail the basis for your position and provide supporting documentation as one or more exhibits to this response.
RESPONDENT:
BY:
Representative
ACKNOWLEDGEMENT
I, the undersigned, do hereby certify that I have read the statements and facts set forth in the foregoing Response of State Agency and state that they are true to the best of my knowledge and belief.
Subscribed and sworn to before me
this
day of
, 19
Notary Public