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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 >> Caretaker Supplement Help 

Customer Help - Caretaker Supplement (CTS)

Forms

Application F-22571 (PDF, 288KB) To apply for Caretaker Supplement  benefits.

Caretaker Supplement (CTS) Instructions for Application (English, Spanish) (PDF)

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, (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: March 26, 2014