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All Income Maintenance (IM) Forms

Below is a list of all Income Maintenance (IM) forms. 

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-10188 Undue Hardship Waiver Decision for Facility DMS English 04/2017 Word No
F-10162 Verification of Veterans Benefits DMS English 12/2022 PDF No
F-16039 Waiver of Administrative Disqualification Hearing DMS English 07/2023 PDF No
F-16039AR Waiver of Administrative Disqualification Hearing, Arabic DMS Arabic 07/2023 PDF No
F-16039CM Waiver of Administrative Disqualification Hearing, Chinese (Simplified) DMS Chinese (Simplified) 07/2023 PDF No
F-16039G Waiver of Administrative Disqualification Hearing, German DMS German 05/2018 PDF No
F-16039H Waiver of Administrative Disqualification Hearing, Hmong DMS Hmong 07/2023 PDF No
F-16039KU Waiver of Administrative Disqualification Hearing, Kurdish DMS Kurdish 05/2018 PDF No
F-16039L Waiver of Administrative Disqualification Hearing, Laotian DMS Laotian 05/2018 PDF No
F-16039R Waiver of Administrative Disqualification Hearing, Russian DMS Russian 07/2023 PDF No
F-16039SO Waiver of Administrative Disqualification Hearing, Somali DMS Somali 07/2023 PDF No
F-16039S Waiver of Administrative Disqualification Hearing, Spanish DMS Spanish 07/2023 PDF No
F-10141 Wisconsin Funeral and Cemetery Aids Program Application DMS English 05/2022 PDF No
F-10144 Wisconsin Life Insurance Inquiry DMS English 05/2019 Word No
F-10093 Wisconsin Medicaid and BadgerCare Plus Overpayment Notice DMS English 09/2019 Word No
F-10101 Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet DMS English 03/2024 PDF Yes
F-10101DA Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Dari DMS Dari (Afghan Persian) 03/2024 PDF No
F-10101H Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Hmong DMS Hmong 03/2024 PDF No
F-10101PA Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Pashto DMS Pashto 03/2024 PDF No
F-10101S Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Spanish DMS Spanish 03/2024 PDF No
F-10140 Wisconsin Medicaid Supplement to FoodShare Wisconsin Application DMS English 10/2012 PDF No
F-10140S Wisconsin Medicaid Supplement to FoodShare Wisconsin Application, Spanish DMS Spanish 10/2012 PDF No
F-10129 Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application DMS English 06/2023 PDF No
F-10129H Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Hmong DMS Hmong 06/2023 PDF No
F-10129S Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Spanish DMS Spanish 06/2023 PDF No
F-10147 Wisconsin Veterans Home at King - Medicaid Review DMS English 07/2008 PDF No
F-10075 Wisconsin Well Woman Medicaid Application and Renewal DMS English 10/2024 PDF Yes
F-10075S Wisconsin Well Woman Medicaid Application and Renewal, Spanish DMS Spanish 10/2024 PDF No
F-10150B Your Rights and Responsibilities for FoodShare DMS English 08/2020 PDF No
F-10150BAR Your Rights and Responsibilities for FoodShare, Arabic DMS Arabic 08/2020 PDF No
F-10150BCM Your Rights and Responsibilities for FoodShare, Chinese (Simplified) DMS Chinese (Simplified) 08/2020 PDF No
F-10150BG Your Rights and Responsibilities for FoodShare, German DMS German 08/2020 PDF No
F-10150BH Your Rights and Responsibilities for FoodShare, Hmong DMS Hmong 08/2020 PDF No
F-10150BL Your Rights and Responsibilities for FoodShare, Laotian DMS Laotian 08/2020 PDF No
F-10150BR Your Rights and Responsibilities for FoodShare, Russian DMS Russian 08/2020 PDF No
F-10150BSO Your Rights and Responsibilities for FoodShare, Somali DMS Somali 08/2020 PDF No
F-10150BS Your Rights and Responsibilities for FoodShare, Spanish DMS Spanish 08/2020 PDF No
F-10150A Your Rights and Responsibilities for Health Care DMS English 06/2018 PDF No
F-10150 Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare DMS English 07/2018 PDF No
F-10150AR Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Arabic DMS Arabic 07/2018 PDF No
F-10150CM Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Chinese (Simplified) DMS Chinese (Simplified) 07/2018 PDF No
F-10150G Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, German DMS German 07/2018 PDF No
F-10150H Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Hmong DMS Hmong 07/2018 PDF No
F-10150L Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Laotian DMS Laotian 07/2018 PDF No
F-10150R Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Russian DMS Russian 07/2018 PDF No
F-10150SO Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Somali DMS Somali 07/2018 PDF No
F-10150S Your Rights and Responsibilities for Health Care (Medicaid, BadgerCare Plus, Family Planning Only) / FoodShare, Spanish DMS Spanish 07/2018 PDF No
F-10150AH Your Rights and Responsibilities for Health Care, Hmong DMS Hmong 06/2018 PDF No
F-10150AS Your Rights and Responsibilities for Health Care, Spanish DMS Spanish 06/2018 PDF No

Glossary

 
Last revised January 24, 2023