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Data Collection (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 form, 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-03082C Initial Certification Application for Branch Office or School Branch Office DQA English 08/2022 Word No
F-03082F Initial Certification Application for DHS 75.59 Opioid Treatment Program (OTP) Mobile Unit DQA English 07/2023 Word No
F-03082 Initial Certification or Change of Ownership Application for DHS 75.14 and DHS 75.15 Service Certification DQA English 08/2022 Word No
F-03082A Initial Certification or Change of Ownership Application for DHS 75.49, DHS 75.50, DHS 75.51, and DHS 75.52 Service Certification DQA English 08/2022 Word No
F-03082E Initial Certification or Change of Ownership Application for DHS 75.53-DHS 75.58 Service Certification DQA English 09/2022 Word No
F-03082B Initial Certification or Change of Ownership Application for DHS 75.59 Service Certification DQA English 08/2022 Word No
F-03082D Initial Certification or Change of Ownership Application for DHS 75.60 Service Certification DQA English 08/2022 Word No
F-47463J Initial EMS Service Providers Operational Plan Components Checklist DPH English 09/2022 Word No
F-02996 Initial Lead Abatement Certification Application DPH English 10/2023 PDF No
F-02996S Initial Lead Abatement Certification Application, Spanish DPH Spanish 11/2023 PDF No
F-02031 Initial Lead Application - Individual Certification DPH English 11/2023 PDF No
F-10097 Institutional Medicaid Income Allocation DMS English 04/2024 PDF No
F-10097H Institutional Medicaid Income Allocation, Hmong DMS Hmong 04/2024 PDF No
F-10097S Institutional Medicaid Income Allocation, Spanish DMS Spanish 04/2024 PDF No
F-00556 Instructions DMS English 01/2018 PDF No
F-20942I Instructions OPIB English 05/2019 PDF No
F-01189A Instructions DMS English 02/2020 PDF No
F-01188A Instructions DMS English 02/2020 PDF No
F-11136A Instructions DMS English 10/2008 PDF No
F-00286 Instructions DMS English 07/2015 PDF No
F-11040A Instructions DMS English 12/2019 PDF No
F-00232 Instructions DMS English 12/2021 PDF No
F-01187A Instructions DMS English 02/2018 PDF No
F-02382I Instructions DMS English 10/2020 PDF No
F-11079 Instructions DMS English 07/2017 PDF No
F-00202 Instructions (PDF, 177 KB) DCTS English 08/2016 PDF No
F-80983A Instructions - Completing the Civil Rights Complaint OLC English 04/2024 PDF No
F-80983ABU Instructions - Completing the Civil Rights Complaint, Burmese OLC Burmese 04/2024 PDF No
F-80983AH Instructions - Completing the Civil Rights Complaint, Hmong OLC Hmong 04/2024 PDF No
F-80983AS Instructions - Completing the Civil Rights Complaint, Spanish OLC Spanish 04/2024 PDF No
F-00989I Instructions for Completing Wisconsin's Individualized Family Service Plan (IFSP) DMS English 03/2017 PDF No
F-00950I Instructions for Coverage Decision Letter DMS English 01/2024 PDF No
F-03112I Instructions for Logging HMO Appeals DMS English 01/2024 PDF No
F-02466I Instructions for Logging MCO Appeals DMS English 12/2022 PDF No
F-02466AI Instructions for Logging MCO Grievances DMS English 12/2022 PDF No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 Word No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 PDF No
F-00539 Instructions for the County Waiver Agency Support and Service Coordination (SSC) Rates DMS English 09/2019 PDF No
F-44623I Instructions for WIC Time Study and Non-WIC Time Study DPH English 06/2020 PDF No
F-20582I Instructions, English DMS English 03/2023 PDF No
F-20582IH Instructions, Hmong DMS Hmong 03/2023 PDF No
F-00107 Instructions, Self-Employment Income Report DMS English 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Chinese Mandarin DMS Chinese Mandarin 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Hmong DMS Hmong 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Spanish DMS Spanish 06/2019 PDF No
F-20582IS Instructions, Spanish DMS Spanish 03/2023 PDF No
F-01721 Instructions-Calculating CLTS Foster Care Room and Board Expenses DMS English 03/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records DMS English 02/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish DMS Spanish 02/2017 PDF No
F-02717A Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 04/2023 PDF No

Glossary

 
Last revised December 8, 2023