DQA Regulated Entity
New Applicant and Existing
Four Year Renewal
Caregiver Background Check Process
Welcome to the Division of Quality Assurance (DQA) automated caregiver
background check process. Caregiver Background Checks (CBC) are
completed by DQA on all new and/or existing license applicants/license
holders, some principal officers and non-client residents of DQA-regulated
Please note this automated process is not for employees/contractors.
See the the Employees/Contractors Background
Check Process for information.
Listed below is information on specific types of
individuals who are required to complete a CBC, and how to complete the
required Background Information Disclosure (BID) form by using either
the Online Caregiver Background Check application or the manual BID submission
New Applicant Information
Caregiver background checks are required on the following individuals
in all NEW DQA-regulated facilities/entities:
- Principal Officers, corporation or board members of the
business organization if they have regular, direct contact
- Non-client residents – Individuals age 10 and older who
are not clients but who reside at the entity if they have
regular, direct contact with clients.
- License Holders/Legal Representatives - License holder
includes all individuals who apply for regulatory approval to
operate any entity regulated by DQA. These individuals must complete
whether or not the person has regular, direct contact with clients.
If the facility/entity owner is a corporation or other type of
business that does not have a single owner, such as (but not limited
- domestic corporation,
- non-stock corporation,
- limited liability company,
then the organization must designate a representative to legally
represent the facility/entity for the purposes of fulfilling the
background check requirements.
License/Legal Representative Responsibility
The license holder/legal representative must ensure all required
individuals as identified above, complete the online CBC process.
Four Year Renewal Information
Every four years the Division of Quality Assurance (DQA) is
required to complete caregiver background checks on all license holders,
board members and non-client residents in all existing DQA-regulated
Online CBC Application
By using the
Online Caregiver Background Check application, you may:
- Complete the background check process for new license holders.
- Complete the 4 year criminal background check requirement for
existing license holders.
- Update your current license information.
- Existing license holders can add a new facility.
- Complete and print the Background Information Disclosure (BID) form (F-82064)
for your records or submit by mail.
- Pay online the $10.00 processing fee for a background check with
a VISA or MasterCard credit or
Note: Only VISA or MasterCard credit or debit cards are
accepted online. If paying by check or money order you should still
complete the online CBC process through the online CBC application. The
application fee cannot be refunded or prorated. DHS charges an
additional fee for checks not honored by the bank. You should print the
completed BID form that is available at the end of the online
application. Submit by mail the BID form and $10.00 processing fee to
the address listed under the Manual BID Submission area below.
Online Caregiver Background Check
application to begin the background check process.
Manual BID Submission
DQA highly recommends using the online CBC application to complete and submit the BID form
and BID Appendix form as it
is faster and more efficient. If you do not use the online CBC process,
you must print out a blank BID form and BID Appendix form and complete
the forms manually.
Include a $10.00 processing fee for each person, payable to
"Division of Quality Assurance.”
Submit the completed BID forms, supporting documents, and payment to:
Entity Background Checks
Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969
If you need assistance completing this form, call 608-261-8319
Monday-Friday, 8:00 am - 4:30 pm.
February 14, 2014