Your business, registered
The form asks for your corporation or LLC exactly as registered with the Illinois Secretary of State (or county), and your Illinois registered agent, whose address must be in Illinois.
Illinois · Home services agency license · IDPH form 445104
Illinois home services license application: form 445104, item by item
An Illinois home services license starts with an envelope: IDPH’s paper form 445104, your policies and client documents, Attachment E for your manager, an insurance certificate and a $1,500 check. Here is every page of the form, every document to enclose, where to mail it, and what happens next.
- Rule-verified October 1, 2026
- Quoted from 77 Ill. Adm. Code 245
- From IDPH’s own form (archived copy)
Quick answer
You apply for an Illinois home services agency license on paper. Fill in IDPH’s Home Services Application, form 445104, and mail it with the documents it lists and a $1,500 check or money order payable to the Illinois Department of Public Health. The form says "electronic submissions and payments are not accepted at this time". The $1,500 is IDPH’s fee, not a CareRulebook price, and it is not refundable.
Illinois reads your policies before it licenses you. First-time applicants enclose nine policies, job descriptions, an insurance certificate, a sample service plan form, proof of Health Care Worker Registry access and Attachment E for the agency manager. IDPH reviews the package within 30 days, it must be complete within 90 days, and a 240-day provisional license follows.
IDPH’s website did not respond when we checked, so this page uses Internet Archive copies of IDPH’s documents: form 445104 (marked “Updated 8/9/2023”), its FAQ and its change of ownership guidance as archived on March 21, 2026, and Attachment E and the survey checklist as archived on August 30, 2025. The rules come from the Illinois General Assembly’s site directly. IDPH may have a newer form: call 217-782-7412 before you mail anything.
What to have ready before you fill it in
The form asks for these, so put them in place first.
A governing body and its officers
The form names the officers. Corporations registered with the Secretary of State give a president and a secretary; other entity types list only the president. The governing body adopts your policies.
An agency manager and a written alternate
Both appear on the staff list, and the manager completes Attachment E. The rule sets no degree or license for the manager, and no nurse is required.
IDPH web portal and registry access
Proof that the agency is registered with the IDPH web portal and can use the Health Care Worker Registry goes in the envelope, so set it up first.
A liability insurance certificate
At least $1 million per occurrence and $3 million in the aggregate. The rule says the application “shall be accompanied by” the certificate.
Your written policies and client documents
The form’s nine policies (plus mandated reporting, and dementia training if you serve clients with dementia), job descriptions, your client contract, scope of services, fee schedule and a sample service plan form. The full list is below.
Form 445104, page by page
One form covers initial, renewal and change of ownership applications. Here is what each of its ten pages asks, as printed on the copy archived on March 21, 2026.
Page 1
Cover and instructions
Where to mail it, the $1,500 fee, the phone number for questions, and a note that typed forms are filled in Adobe; if you write by hand, watch for the drop-down boxes. The fee is not refundable and filing does not guarantee a license.
Form 445104, page 1Page 2
General information
Tick initial, renewal or change of ownership. Agency name, DBA, physical address, phone, optional fax, business hours and days, email, county, fiscal period and mailing address. A manager contact person whose phone number is different from the agency’s. Any branch offices or drop sites.
Form 445104, page 2Page 3
Ownership
Type of organization (governmental, non-profit or proprietary), the legal entity as registered, your Illinois registered agent, and for corporations each shareholder with more than 5% of the common stock.
Form 445104, page 3Page 4
Declarations and governing body
A sole proprietor signs a child support declaration (others tick N/A). The officers of the governing body. Whether the applicant, any officer or director, or the manager has a felony, or two or more moral-turpitude misdemeanors, in the last five years, with an explanation as Exhibit A for any yes. Whether the manager runs another Illinois agency.
Form 445104, page 4Page 5
Revenue and clients
Sources of revenue, with at least one “other funds” box ticked (self-pay, HMO/PPO, commercial insurance or other). Admissions, admissions aged 65 or over, discharges and current clients for the last fiscal period, leaving out Community Care Program, DHS and VA clients; enter a zero where there are none.
Form 445104, page 5Page 6
Geographic service area
Every county you will serve, with an asterisk for part of a county. No radius miles, and the counties must be contiguous.
Form 445104, page 6Page 7
All employees
Each employee’s initials and title, full time, part time or contract, including the agency manager and alternate. Never Social Security numbers. For a contracted worker, attach the contract with that worker.
Form 445104, page 7Page 8
Required documents and affidavits
The list of documents to enclose (below), an affidavit naming the agency manager, and the affidavit of agreement, signed by the manager with an original signature.
Form 445104, page 8Pages 9 and 10
Attachment E
The Agency Manager Qualification Review Form, for initial applications and any change of manager: work experience, licenses held (with a copy of any current Illinois license), and any criminal conviction or license action, explained in detail.
Form 445104, page 9; Attachment E
Two differences between the form and the rule. The rule asks about convictions “during the previous year”, but the form asks about “the last FIVE years”, and Attachment E asks the manager "Have you ever been convicted of a criminal offense?" with no time limit. Answer each question exactly as it is asked (245.90(a)(3)(C)(iii); Form 445104, page 4). And the form’s attachment list leaves out two policies the rule names, mandated reporting and dementia training; they are in the envelope list below.
What goes in the envelope
Page 8 of the form lists the documents to enclose. Three go with every application; thirteen more go with a first application only. The last column shows where each one is in CareRulebook’s Illinois manual, whose policy 1.5 holds this same checklist.
With every application (initial, renewal and change of ownership)
| Document | Rule | Manual policy |
|---|---|---|
| Your current client contract, with any attachments it names (for example rights and responsibilities, the service plan, a rate sheet) | 245.220 | 2.3 |
| Your scope of services | 245.40(c); 245.210(a) | 2.1 |
| Your fee schedule | 245.90(a)(3)(H) | 2.1 |
With a first application only
| Document | Rule | Manual policy |
|---|---|---|
| Job descriptions for all positions | 245.30(c)(1)(D) | 3.1 |
| Proof of general liability coverage ($1 million / $3 million) | 245.90(a)(2) | Your insurer’s certificate (1.4) |
| Complaint resolution policy | 245.30(b)(3) | 2.4 |
| Employee health and safety policy | 245.30(c)(1)(H)-(I) | 3.3, 3.4 |
| Infection control policy | 245.75 | 7.1 |
| Health care worker background check process | 955.145, 955.165, 955.220 | 3.5 |
| Supervisory visit for client policy | 245.40(c)(6)(B) | 5.5 |
| Supervisory visit for home services worker policy | 245.40(c)(6)(B)(i)-(iii) | 5.5 |
| Client records management and release | 245.210(h)-(j) | 10.1, 10.2, 10.3 |
| Employee training procedures | 245.71 | 4.1, 4.2 |
| Acceptance of client policy | 245.210(d) | 2.2 |
| Sample service plan form | 245.210(e) | 5.1 |
| Proof of access to the Health Care Worker Registry | 955.115 | A screenshot of your access (3.5) |
IDPH, Home Services Application, Form 445104, page 8 (archived March 21, 2026). Section numbers are in 77 Ill. Adm. Code 245 or 955.
Also in the envelope
Attachment E for the agency manager, with a copy of any current Illinois professional licenseManual 1.2
Initial, and on a change of manager
Form 445104, page 9Exhibit A, explaining any conviction
If any answer on page 4 is yes
Form 445104, page 4A copy of the contract with each contracted home services workerManual 1.7
If any worker is contracted
Form 445104, page 7Your mandated reporting policyManual 6.1
Initial (the rule pairs it with background checks)
245.90(a)(3)(I)(iv)Your dementia training, if you serve clients with dementiaManual 5.4
Initial (the rule names 245.211)
245.90(a)(3)(I)(vii)The $1,500 IDPH fee, by check or money order payable to the Illinois Department of Public Health
Every application
Form 445104, page 1The rule lists the same policy areas a little differently: complaint resolution, employee health and safety, infection control, background check and mandated reporting compliance, supervisory visits, client records management, retention and release, and employee training, including the dementia training rules in 245.211 (245.90(a)(3)(I)). Sending the mandated reporting and dementia training policies covers both lists.
CareRulebook
Every document in the envelope, written for your agency
CareRulebook’s Illinois manual writes every policy on IDPH’s list, and the rest it checks at the survey, with your agency’s details and the rule quoted under each. Policy 1.5 maps each item on form 445104 to the policy that answers it, so you can assemble the envelope from the table.
- 37 policies, 113 rule requirements mapped
- Client contract, scope of services and sample service plan form included
- Live preview before you pay
- Editable Word and PDF, delivered instantly
Preview your manual
$199CareRulebook founding price for the first 50 Illinois agencies, then $249. Not an IDPH fee.
Mailing it and paying
Mail to
Illinois Department of Public Health
Health Care Facilities and Programs Section
525 W. Jefferson St., Fourth Floor
Springfield, IL 62761-0001
Pay
$1,500 by check or money order, made payable to the Illinois Department of Public Health. This is IDPH’s license fee, not a CareRulebook price. It is not refundable, and filing does not guarantee a license.
Form 445104, page 1- No electronic filing. The form says "electronic submissions and payments are not accepted at this time". Form 445104, page 1
- Keep a copy. "Retain a copy of the application for future reference." IDPH’s surveyors later ask for a copy of your current license application. Form 445104, page 1
- Original signatures. The agency manager signs the affidavit of agreement and Attachment E in original. Misrepresentation can be cause for denial, or revocation later. Form 445104, page 8
- Questions first. Call IDPH on 217-782-7412 (TTY 800-547-0466). Form 445104, page 1
- Our suggestion: send it by a tracked service and note the delivery date, because IDPH’s 30-day review and 90-day deadline run from submission. This is our advice, not an IDPH rule.
After you mail it
Tick steps off as you go; progress is saved in this browser only.
IDPH’s first review
Within 30 daysIDPH reviews a new application within 30 days and emails the address on the application for any revisions. It communicates with your agency representative only by email, fax or phone, so check that inbox every working day.
Complete within 90 days
By day 90The application must be completed and approved within 90 days of submission, or it may be denied. The rule itself says incomplete applications may be denied.
Provisional license
Within 90 daysIDPH issues a provisional license to a new agency within 90 days of receiving an application that complies with 245.90. It lasts 240 days, and the initial fee covers it.
Operational requirements
First six monthsWithin the first six months of the provisional license, IDPH tells you which operational requirements must be in place for the licensure survey.
Licensure survey
Last 30 days of the 240IDPH inspects in the last 30 days of the provisional license. IDPH’s surveyor checklist, which its FAQ points to for renewal surveys (there is no separate list for the first survey), asks for your manuals, bylaws, minutes, client and staff lists, insurance certificate, complaint log, training files, registry verifications, a copy of your license application, service plans and your dementia training curriculum. If you are not ready but have made significant progress, IDPH may renew the provisional license once, for up to 90 days.
Full license
After the surveyIf you substantially meet the requirements, IDPH issues the license. Your first full license expires one year from the end of the month the provisional license was first issued.
From a compliant application to a full license is roughly 7 to 11 months, longer if the provisional license is extended. That is our arithmetic from the limits above, not an IDPH estimate. Fees and timeline on the Illinois guide →
IDPH fees
| IDPH fee | Amount | Source |
|---|---|---|
| Home services agency license: initial, renewal or change of ownership (one year) | $1,500 | Form 445104, page 1 |
| Rule cap for a home services agency license | up to $1,500 a year | 245.95(b) |
| Home services placement agency license (one year) | $500 | Placement application, page 1 |
These are IDPH’s fees, paid to the state, not CareRulebook prices. They are not refundable. An applicant for more than one license sends an application and fee for each, and certified local health departments pay no fee (245.95(a)-(b)). Workers other than nurse aides may be asked to pay their own fingerprinting fees (955.165(j)(3)).
Renewing every year
The license lasts one year. "Each licensee shall file a renewal application with the Department not less than 60 days, or more than 90 days, prior to the expiration date of the licensee's current license." (245.90(b)(1)). The form’s cover page puts it plainly: "DUE DATE IS 60 DAYS PRIOR TO THE EXPIRATION OF THE CURRENT LICENSE". Missing the 60-day mark can bring a fine.
A renewal uses the same form 445104, ticked as a renewal, with:
- your current client contract and its attachments, scope of services and fee schedule (the three documents every applicant sends);
- client numbers for the past year: admissions, those aged 65 or over, discharges and clients on service, leaving out Community Care Program, DHS and VA clients (245.90(d)(1));
- conviction information for the licensee and its officers (245.90(b)(3));
- if you served five or fewer clients in the last fiscal period, one client’s signed contract, service plan and first and last week of daily care notes, sent by fax to 217-524-0488 (Form 445104, page 5); and
- the $1,500 IDPH fee.
Two more points. "Requests for additional or removed geographic areas will not be processed from the application." (Form 445104, page 6), so request county changes separately. And you must be operating and able to show client activity before your second renewal (245.90(e)).
Changes, branches, selling and closing
A license covers only the agency named in the application and cannot be transferred or assigned (245.80(d)(1)). For everything else, the notice or approval depends on what changes.
Name, manager, address, hours, phone, fax or email
Within 10 days
Tell IDPH, including changes at branches. IDPH’s FAQ names its Facility Information Change Form for these changes, and form 445104 asks for a new Attachment E on your application whenever the agency manager has changed.
245.80(h); IDPH FAQAdding or removing counties
Approval first
Use IDPH’s Geographic Service Area Request Form, by mail or email to DPH.COOS@illinois.gov, and do not serve a new county until it is approved. A renewal application cannot change counties.
245.80(i); IDPH FAQA branch office or drop site
Approval first
Send the Branch/Drop-Site Questionnaire with a travel map showing distance and time, an organization chart and your monthly supervisory visit form. A branch must be within 100 miles of the parent office.
245.80(k); IDPH questionnaireSelling the agency or changing ownership
30 days before
The seller tells IDPH in writing at least 30 days ahead. The buyer files form 445104 as a change of ownership, with the fee and supporting documents, at least 30 days before the sale, then sends the final bill of sale. The sale is not complete until IDPH issues the buyer’s license; the seller returns its license by certified mail.
245.80(d); IDPH CHOW guidanceClosing the agency or a branch
30 days before
Written notice with the reasons, where client records will be and who holds them. Transfer active clients’ records to the receiving agency and tell IDPH which, then surrender the license by certified mail when services stop.
245.80(g)IDPH’s change of ownership guidance adds: "Note, the license should not be allowed to expire during the change of ownership process." Once the buyer is licensed, the seller’s license is no longer valid (IDPH Change of Ownership Guidance, archived March 21, 2026).
Myths about applying
Is an Illinois home services license good for two years?
No. A home services agency license lasts one year and costs $1,500. The two-year, $1,500 license is for home health agencies. File each renewal 60 to 90 days before the license expires.
"Each license shall be for a term of one year and shall expire one year from the date of issuance."
Do you need a registered nurse to run an Illinois home services agency?
No. A home services agency designates a person to supervise services, and its supervisors and trainers need hands-on experience with home services tasks, not a nursing license. An RN or APRN supervisor is required for a home nursing agency, which is a different license.
"A home services agency shall designate a person to supervise the provision of services or to oversee the placement of workers through the licensed home services agency."
Do companion-only or housekeeping businesses in Illinois need a home services license?
It depends. Companionship is a home service, so a companion agency needs a license. Only an agency that limits its business exclusively to housecleaning is outside the definition. Advertising companion or personal care services without a license is itself prohibited.
"does not include an agency that limits its business exclusively to providing housecleaning services"
Does each Illinois branch office need its own home services license?
No. If IDPH approves it as a branch: within 100 miles of the parent office, inside your service area, offering the same services, with monthly documented supervisory visits. Each franchise entity, though, needs its own license, and an unapproved second location can be fined up to $100 a day or required to get a separate license.
"A branch office shall be part of the agency and shall be located close (but not more than 100 miles from the parent office location) and shall provide the same services as the parent office"
Frequently asked questions
How do I apply for a home care license in Illinois?
Fill in IDPH’s Home Services Application, form 445104, and mail it with the documents it lists and a $1,500 check or money order payable to the Illinois Department of Public Health, to IDPH Health Care Facilities and Programs, 525 W. Jefferson St., Fourth Floor, Springfield, IL 62761-0001. First-time applicants also send nine policies, job descriptions, proof of insurance, a sample service plan form, proof of Health Care Worker Registry access and Attachment E for the agency manager.
Can I apply for an Illinois home services license online?
Not according to IDPH’s form as archived on March 21, 2026: it says electronic submissions and payments are not accepted. You mail the application and pay by check or money order. IDPH then communicates by email, fax or phone. Call 217-782-7412 before you mail it to confirm you have the current form.
How much does the Illinois home services license cost?
IDPH charges $1,500 for each initial, renewal or change of ownership application, for a one-year license. It is not refundable. A home services placement agency license is $500. These are IDPH’s fees, not CareRulebook prices.
What policies do I send with the application?
IDPH’s form asks first-time applicants for policies on complaint resolution, employee health and safety, infection control, the health care worker background check process, supervisory visits for clients, supervisory visits for workers, client records management and release, employee training and acceptance of clients. The rule also lists mandated reporting alongside background checks, and dementia training if you serve clients with dementia, so send those too.
How long does IDPH take to review the application?
IDPH says it reviews a new application within 30 days and emails you for any revisions, and the application must be complete and approved within 90 days or it may be denied. The provisional license follows within 90 days of a compliant application.
What is Attachment E?
The Agency Manager Qualification Review Form. It goes with every initial application and whenever the agency manager changes. It describes the manager’s work experience and licenses, with a copy of any current Illinois license, and asks about criminal convictions and license actions.
Does the agency manager need to be a nurse?
No. A home services agency designates a person to supervise services; the rule sets no degree or license. IDPH reviews the manager’s experience on Attachment E.
Who do I call at IDPH about the application?
IDPH’s number for application questions is 217-782-7412 (TTY 800-547-0466), as printed on form 445104.
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The North Carolina license application
DHSR also reviews your policies before it licenses you.
Georgia
The Georgia license application
GAHLES and a three-month provisional license.
Virginia
The Virginia license application
The VDH OLC Portal, 60 days before opening.
Sources
- 77 Ill. Adm. Code 245, Home Health, Home Services, and Home Nursing Agency Code (current through 50 Ill. Reg. 2147, effective January 30, 2026) · Illinois Department of Public Health (Illinois Administrative Code, Joint Committee on Administrative Rules, ilga.gov) · retrieved October 1, 2026
- Home Health, Home Services, and Home Nursing Agency Licensing Act (210 ILCS 55) · Illinois General Assembly (Illinois Compiled Statutes, ilga.gov) · retrieved October 1, 2026
- 77 Ill. Adm. Code 955, Health Care Worker Background Check Code · Illinois Department of Public Health (Illinois Administrative Code, ilga.gov) · retrieved October 1, 2026
- Home Services Agencies Frequently Asked Questions (archived copy of March 21, 2026) · Illinois Department of Public Health · retrieved October 1, 2026
- Home Services Application, Form 445104 (Initial, Renewal and Change of Ownership; archived copy of March 21, 2026) · Illinois Department of Public Health · retrieved October 1, 2026
- Home Services Placement Initial, Renewal and Change of Ownership Application (archived copy of March 21, 2026) · Illinois Department of Public Health · retrieved October 1, 2026
- Surveillance Nurse Visit Checklist (Home Services) (archived copy of August 30, 2025) · Illinois Department of Public Health · retrieved October 1, 2026
- Agency Manager Qualification Review Form, Attachment E (archived copy of August 30, 2025) · Illinois Department of Public Health · retrieved October 1, 2026
- Branch/Drop-Site Questionnaire (archived copy of May 10, 2026) · Illinois Department of Public Health · retrieved October 1, 2026
- Change of Ownership Guidance (archived copy of March 21, 2026) · Illinois Department of Public Health · retrieved October 1, 2026