F-02717AH |
Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong |
DMS |
Hmong |
04/2023 |
PDF |
No |
F-02717AS |
Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish |
DMS |
Spanish |
04/2023 |
PDF |
No |
F-01234A |
Instructions: Explanation of Medical Benefits |
DMS |
English |
11/2023 |
PDF |
No |
F-16030B |
Instructions: FoodShare Wisconsin Overpayment Calculator |
DMS |
English |
01/2018 |
PDF |
No |
F-22540 |
Instructions: Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs |
OPIB |
English |
05/2019 |
PDF |
No |
F-10110A |
Instructions: Medicaid/BadgerCare Plus Eligibility Certification |
DMS |
English |
01/2018 |
HTML |
No |
F-02074A |
Instructions: Medicare Other Coverage Discrepancy Report |
DMS |
English |
04/2018 |
PDF |
No |
F-11133A |
Instructions: Personal Care Screening Tool (PCST) |
DMS |
English |
08/2017 |
PDF |
No |
F-11010A |
Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format |
DMS |
English |
01/2018 |
PDF |
No |
F-11008A |
Instructions: Prior Authorization / Therapy Attachment (PA/TA) |
DMS |
English |
05/2019 |
PDF |
No |
F-01248A |
Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal |
DMS |
English |
08/2016 |
PDF |
No |
F-00219 |
Instructions: Self-Employment Income Report: Farm Business |
DMS |
English |
06/2019 |
PDF |
No |
F-00219 |
Instructions: Self-Employment Income Report: Farm Business, Chinese Mandarin |
DMS |
Chinese Mandarin |
06/2019 |
PDF |
No |
F-00219 |
Instructions: Self-Employment Income Report: Farm Business, Hmong |
DMS |
Hmong |
06/2019 |
PDF |
No |
F-00219 |
Instructions: Self-Employment Income Report: Farm Business, Spanish |
DMS |
Spanish |
06/2019 |
PDF |
No |
F-22637 |
Interagency Notification -Termination of Community Waiver Participation |
DMS |
English |
03/2017 |
PDF |
No |
F-10142 |
Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant |
DMS |
English |
07/2008 |
PDF |
No |
F-42010 |
Interjurisdictional Tuberculosis Notification |
DPH |
English |
03/2003 |
PDF |
No |
F-42011 |
Interjurisdictional Tuberculosis Notification - Follow-up |
DPH |
English |
03/2003 |
PDF |
No |
F-47463D |
Intermediate Operational Plan Components |
DPH |
English |
06/2012 |
PDF |
No |
F-47463C |
Intermediate Technician Operational Plan Components |
DPH |
English |
06/2012 |
PDF |
No |
F-03010 |
Intoxicated Driver Program Assessor Training Application |
DCTS |
English |
03/2022 |
HTML |
No |
F-01761 |
Intoxicated Driver Program Self-Evaluation |
DCTS |
English |
09/2016 |
Word |
No |
F-20891 |
Intoxicated Driver Program Supplemental Funding Request |
DCTS |
English |
09/2023 |
Word |
No |
F-02961 |
Introduction to Community Recovery Services Presentation Evaluation Survey |
DCTS |
English |
02/2022 |
HTML |
No |
F-00075 |
IRIS (Include, Respect, I Self-Direct) Authorization |
DPH |
English |
02/2024 |
Word |
No |
F-00075 |
IRIS (Include, Respect, I Self-Direct) Authorization (DocuSign) |
DPH |
English |
02/2024 |
HTML |
No |
F-00075LP |
IRIS (Include, Respect, I Self-Direct) Authorization (Large Print) |
DPH |
English |
02/2024 |
Word |
No |
F-00075AR |
IRIS (Include, Respect, I Self-Direct) Authorization, Arabic |
DPH |
Arabic |
02/2024 |
PDF |
No |
F-00075CM |
IRIS (Include, Respect, I Self-Direct) Authorization, Chinese (Mandarin) |
DPH |
Chinese Mandarin |
02/2024 |
Word |
No |
F-00075H |
IRIS (Include, Respect, I Self-Direct) Authorization, Hmong |
DPH |
Hmong |
02/2024 |
Word |
No |
F-00075L |
IRIS (Include, Respect, I Self-Direct) Authorization, Laotian |
DPH |
Laotian |
02/2024 |
Word |
No |
F-00075R |
IRIS (Include, Respect, I Self-Direct) Authorization, Russian |
DPH |
Russian |
02/2024 |
Word |
No |
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-02021 |
IRIS - Certified Public Accountant (CPA) Audit Checklist |
DMS |
English |
02/2017 |
Word |
No |
F-01210A |
IRIS Budget Amendment Provider Quote Comparison |
DMS |
English |
02/2017 |
Word |
No |
F-01210 |
IRIS Budget Amendment Request |
DMS |
English |
12/2017 |
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 |