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Wisconsin Department of Health Services

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ACCESS

BadgerCare Plus for Families 

Family Planning Only Services

FoodShare

Medicaid

SeniorCare

Caretaker Supplement

Fair Hearing Request

Fair Hearing Withdrawal

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Eligibility Management (Income Maintenance) Home >> Customer Help >> FoodShare Help >> 

Customer Help - FoodShare

To see if you may be eligible or to apply, go to access.wi.gov.

Forms

Application Registration F-16019A (PDF, 410KB)   A short form to get you started with with your FoodShare request.  

Application F-16019B (PDF, 472KB) A full application for FoodShare.  

Income Change Report F-16066 (PDF, 111KB) To report changes in your income.  You can also report changes online at access.wisconsin.gov.

Change Report F-16006  (PDF, 110KB)  For people who are age 60 or over, blind or a person with a disability to report changes.  You can also report changes online at access.wisconsin.gov.

Designation of Authorized Buyer or Alternate Payee F-16004 (PDF, 100KB) To appoint someone to be able to help you use your benefits.

Authorization of Representative F-10126 (English, Hmong, Spanish) (PDF, 600KB) To appoint someone to apply for FoodShare for you.

Fair Hearing Request (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, (PDF  KB) Use this form to report self-employment income.

Publications

ACCESS/Marketplace Takeaway Card, P-05555 - (English, Spanish) (PDF, 549KB)

ForwardHealth Enrollment and Benefits Handbook - April 2014
P-00079
(English) (PDF 2.6 MB)
ForwardHealth Enrollment and Benefits Handbook - November 2013
P-00079-P
(English, Spanish) (PDF 3.3 MB)
A handbook will be mailed to each family who applies for a ForwardHealth Plan.

Guide to Applying for Wisconsin's Health and Nutrition Programs P-16091 (English, Hmong, Spanish), (PDF, 181KB)  

EBT Videos- To see Electronic Benefit Transfer (EBT) videos that explain the use of the QUEST card.

ACCESS/Marketplace Takeaway Card, P-05555 - (English, Spanish) (PDF, 549KB)

Healthy Start, Grow Smart: Baby's first year one month at a time

Other Links

More information about Foodshare can be found at dhs.wisconsin.gov/foodshare/.

Agency Directory - To find the telephone number and address of your local agency.

Income Limits - To find current income limits.

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 11, 2014