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Official DHS Forms Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions. When you are searching for a document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

Assigned Number Title Division Language Release Date File Type Available to Order
F-00075SE IRIS (Include, Respect, I Self-Direct) Authorization, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word No
F-00075SO IRIS (Include, Respect, I Self-Direct) Authorization, Somali DPH Somali 02/2024 Word No
F-00075S IRIS (Include, Respect, I Self-Direct) Authorization, Spanish DPH Spanish 02/2024 Word No
F-02764 IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal DPH English 10/2024 Word No
F-02764LP IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal (Large Print) DPH English 10/2024 Word No
F-02764AR IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Arabic DPH Arabic 10/2024 Word No
F-02764CM IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Chinese (Simplified) DPH Chinese (Simplified) 10/2024 Word No
F-02764H IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Hmong DPH Hmong 10/2024 Word No
F-02764L IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Laotian DPH Laotian 10/2024 Word No
F-02764R IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Russian DPH Russian 10/2024 Word No
F-02764SE IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Serbo-Croatian DPH English 10/2024 Word No
F-02764SO IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Somali DPH Somali 10/2024 Word No
F-02764S IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Spanish DPH Spanish 10/2024 Word No
F-02021 IRIS - Certified Public Accountant (CPA) Audit Checklist DMS English 02/2017 Word No
F-01210A IRIS Budget Amendment Provider Quote Comparison DMS English 12/2024 Word No
F-01210 IRIS Budget Amendment Request DMS English 12/2024 Word No
F-03330 IRIS Caregiver Daily Task Schedule DMS English 11/2024 Word No
F-01209 IRIS Certification Acknowledgment DMS English 02/2017 Word No
F-01549 IRIS Certification Designation of Confidential and Proprietary Information DMS English 02/2017 Word No
F-01208A IRIS Consultant Agency (ICA) Quality Management Plan DMS English 12/2023 Excel No
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist DMS English 08/2020 Word No
F-01208 IRIS Contractor Quality Management Plan - Attachment Cover Sheet DMS English 09/2023 Word No
F-01240 IRIS Critical Incident Reconciliation DMS English 02/2017 Word No
F-01319B IRIS Denial of Enrollment Request DMS English 02/2017 Word No
F-03117 IRIS Electronic Visit Verification (EVV) System or Power Outage Exception Notification DMS English 12/2022 Word No
F-02914 IRIS Electronic Visit Verification Risk Agreement DMS English 06/2023 Word No
F-02046 IRIS Financial Projections Template DMS English 06/2021 Excel No
F-02047 IRIS Financial Reporting DMS English 02/2024 Excel No
F-01208B IRIS Fiscal Employer Agent (FEA) Quality Management Plan DMS English 01/2024 Excel No
F-01319 IRIS Involuntary Disenrollment Request DMS English 02/2017 Word No
F-02488 IRIS Monthly Rate of Service (MROS) Discrepancy Resolution DMS English 02/2022 Excel No
F-02470 IRIS Noncompliance Statement and Corrective Action Plan DMS English 03/2019 Word No
F-01206 IRIS One-Time Expense Request DMS English 02/2017 Word No
F-01206B IRIS One-Time Expense Request - Ramp DMS English 02/2017 Word No
F-01206A IRIS One-Time Expense Vendor Bid Comparison DMS English 02/2017 Word No
F-01947 IRIS Participant Education Manual: Acknowledgement DMS English 11/2018 Word No
F-01947FR IRIS Participant Education Manual: Acknowledgement, French DMS French 11/2018 Word No
F-01947LP IRIS Participant Education Manual: Acknowledgement, Large Print DMS English 11/2018 Word No
F-01205B IRIS Participant Education: Budget Amendments DMS English 03/2017 Word No
F-01205BAR IRIS Participant Education: Budget Amendments, Arabic DMS Arabic 03/2017 PDF No
F-10205BBU IRIS Participant Education: Budget Amendments, Burmese DMS English 03/2017 Word No
F-01205BFR IRIS Participant Education: Budget Amendments, French DMS French 03/2017 Word No
F-01205BH IRIS Participant Education: Budget Amendments, Hmong DMS Hmong 03/2017 Word No
F-01205BKA IRIS Participant Education: Budget Amendments, Karen DMS Karen 03/2017 PDF No
F-01205BKR IRIS Participant Education: Budget Amendments, Korean DMS Korean 03/2017 PDF No
F-01205BR IRIS Participant Education: Budget Amendments, Russian DMS Russian 03/2017 Word No
F-01205BS IRIS Participant Education: Budget Amendments, Spanish DMS Spanish 03/2017 Word No
F-01205C IRIS Participant Education: One-Time Expense Requests DMS English 11/2019 Word No
F-01205CAR IRIS Participant Education: One-Time Expense Requests, Arabic DMS Arabic 11/2019 PDF No
F-01205CH IRIS Participant Education: One-Time Expense Requests, Hmong DMS Hmong 11/2019 Word No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

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Last revised December 4, 2024