Illinois Administrative Code
Title 77 - PUBLIC HEALTH
Part 996 - ANIMAL POPULATION CONTROL CODE
Section 996.500 - Application Forms
Universal Citation: 77 IL Admin Code ยง 996.500
Current through Register Vol. 48, No. 12, March 22, 2024
a) Each companion animal owner or feral cat colony manager shall submit an Application/Eligibility Voucher form to the Department. This form includes the consent form (see Section 996.300(a) ), the veterinarian certificate for reimbursement (see Section 996.700(c) ), and the eligibility voucher (see Section 996.400(d) ).
1) The companion animal owner or feral cat
colony manager shall include his or her name and address, the type of
eligibility claimed (SNAP, SSDI or feral cat colony manager), a description of
the animal or animals to be sterilized, and a signature and date on the consent
form, which is Part I of the Application/Eligibility Voucher.
2) Upon approval, the Department will affix
an approval code, an issue date, and an authorization stamp to Part III of the
form. The approved and stamped form is the eligibility voucher (see Section
996.400(d)
).
3) After an approved eligibility voucher has
been returned, the companion animal owner or feral cat colony manager shall
schedule the sterilization procedure with a participating veterinarian. After
the sterilization procedure is performed, the veterinarian shall include his or
her name, the name and address of the clinic, the date of the sterilization
procedure, the specific immunizations administered, and whether a co-payment
was received (see Section 996.700) on Part II of the Application/Eligibility
Voucher. The veterinarian and the companion animal owner or the feral cat
colony manager shall also sign and date Part II of the form, which is the
veterinarian's certificate for reimbursement.
b) Each participating veterinarian shall submit a Veterinarian Application/Agreement to Participate (Agreement to Participate) form to the Department available on its website at http://www.idph.state.il.us/pdf/Spay_Neuter_Veterinarian_Participation.pdf [File Link Not Available].
1) The
veterinarian shall include his or her name, the name and address of the
veterinary practice, his or her Illinois veterinary medicine license number,
and contact information. The veterinarian shall also indicate which animal or
animals (dogs, domestic cats or feral cats) he or she will accept under this
program.
2) The veterinarian shall
sign and date the Agreement to Participate on the form. This Agreement to
Participate details the veterinarian's duties and responsibilities under the
Act and this Part.
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