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Wisconsin Department of Health Services

Division of Quality Assurance (608) 261-8319

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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 facilities/entities.

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 process.

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 with clients.
     
  • 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 a CBC 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 to):

  • domestic corporation,
  • non-stock corporation,
  • partnership,
  • 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 facilities/entities:

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 debit card.

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.

Use the 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.

Last Revised: August 25, 2014