Section 1101.TABLE A Request for Public Records

To:	FOIA Officer Department of Public Aid 201 South Grand Avenue East Springfield, Illinois 62763-0002 ATTN: FOIA Request			From:
						Name
						Address

						Phone Number
Description of Requested Record(s):
Please indicate if you wish to inspect the above captioned records or wish a copy of them:
Inspection			Copy				Both

For Office Use Only:

		Date Received			Date Response Due

(Source: Amended at 25 Ill. Reg. 674, effective January 1, 2001)