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Eligibility
Management (Income Maintenance) Home >> Customer
Help >> Caretaker Supplement Help
Caretaker Supplement (CTS) Help
Forms
Application
— F-22571
(PDF, 288KB) —
To apply for Caretaker
Supplement benefits.
Caretaker Supplement (CTS) Instructions for Application (English,
Spanish) (PDF)
Request
For Fair Hearing — DHA 28
(PDF, 100KB)*
(exit DHS) —
To request a hearing if you don't agree with a decision about your
benefits.
Fair
Hearing Voluntary Withdrawal — DHA 17
(PDF, 10KB)* (exit
DHS) — If you want to withdraw your request for a hearing.
Self-Employment
Income Report (SEIRF) form —
F-00107,
(English, Hmong,
Spanish)
(PDF KB) — Use this form to report self-employment
income.
Publications
More information can be found at dhs.wisconsin.gov/ssi/caretaker.htm.
Other Links
Agency
Directory - To find the telephone number and address of your local
agency.
Legal
Services - To find the name and telephone number of who in your area
can provide you with legal help. You may also go to:
Last Revised:
April 15, 2013
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