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Eligibility Management (Income Maintenance) Home >> IM Forms

Division of Health Care Financing (DHCF)
Family Care Forms Sorted by Form Number

Last Revised: July 12, 2010

This list contains all Family Care program forms that are available from DHCF. Forms marked as "PDF- Fillable" indicates the PDF form can be filled in using your computer and then printed; see About PDF Forms. If this list includes Microsoft Word or Excel forms, they can be filled in, saved, and transmitted electronically. You must have access to Microsoft Office 97, or a more recent version, to use these forms.

Form Number Form Title Form Type Revised Date Language
F-00009 Unprocessed Family Care, Pace, or Partnership Disenrollment Request PDF 12/1/2008 English
F-00046 Family Care Program Enrollment Instructions and Important Information Word 1/1/2012 English
F-10101 Wisconsin Medicaid for the Elderly, Blind or Disabled Application Packet PDF 6/1/2011 English
F-10101H Wisconsin Medicaid for the Elderly, Blind or Disabled Application / Review Packet - Hmong PDF 3/1/2010 Hmong
F-10101S Wisconsin Medicaid Health Care for the Elderly, Blind and Disabled Application / Review Packet - Spanish PDF 3/1/2010 Spanish
F-13039 Estate Recovery Program (ERP) Disclosure PDF 7/1/2008 English
F-13039A Estate Recovery Program (ERP) Disclosure Instructions PDF 7/1/2008 English
P-00088 A Guide for People Who Are on a Waiting List for Publicly Funded Long-Term Care PDF 3/1/2009 English
P-00088_H A Guide for People Who Are on a Waiting List for Publicly Funded Long-Term Care - Hmong PDF 3/1/2009 Hmong
P-00088_R A Guide for People Who Are on a Waiting List for Publicly Funded Long-Term Care - Russian PDF 3/1/2009 Russian
P-00088_S A Guide for People Who Are on a Waiting List for Publicly Funded Long-Term Care - Spanish PDF 3/1/2009 Spanish
P-00088A What is an Aging and Disability Resource Center? PDF 3/1/2009 English
P-00088AH What is an Aging and Disability Resource Center? - Hmong PDF 3/1/2009 Hmong
P-00088AR What is an Aging and Disability Resource Center? - Russian PDF 3/1/2009 Russian
P-00088AS What is an Aging and Disability Resource Center? - Spanish PDF 3/1/2009 Spanish
P-00088B What is the "Long-Term Care Functional Screen" and How is it Used? PDF 3/1/2011 English
P-00088BH What is the "Long-Term Care Functional Screen" and How is it Used? - Hmong PDF 3/1/2011 Hmong
P-00088BR What is the "Long-Term Care Functional Screen" and How is it Used? - Russian PDF 3/1/2011 Russian
P-00088BS What is the "Long-Term Care Functional Screen" and How is it Used? - Spanish PDF 3/1/2011 Spanish
P-00088C Which Long-Term Care Program is Best for Me? PDF 3/1/2011 English
P-00088CH Which Long-Term Care Program is Best for Me? - Hmong PDF 3/1/2011 Hmong
P-00088CR Which Long-Term Care Program is Best for Me? - Russian PDF 3/1/2011 Russian
P-00088CS Which Long-Term Care Program is Best for Me? - Spanish PDF 3/1/2011 Spanish
P-00088D Tell Me More About Family Care PDF 3/1/2009 English
P-00088DH Tell Me More About…Family Care - Hmong PDF 3/1/2009 Hmong
P-00088DR Tell Me More About Family Care - Russian PDF 3/1/2009 Russian
P-00088DS Tell Me More About…Family Care - Spanish PDF 3/1/2009 Spanish
P-00088E Interdisciplinary Teams in Family Care PDF 3/1/2009 English
P-00088EH Interdisciplinary Teams in Family Care - Hmong PDF 3/1/2009 Hmong
P-00088ER Interdisciplinary Teams in Family Care - Russian PDF 3/1/2009 Russian
P-00088ES Interdisciplinary Teams in Family Care - Spanish PDF 3/1/2009 Spanish
P-00088F Tell Me More About Family Care Partnership PDF 3/1/2011 English
P-00088FH Tell Me More about…Family Care Partnership - Hmong PDF 3/1/2011 Hmong
P-00088FR Tell Me More About Family Care Partnership - Russian PDF 3/1/2011 Russian
P-00088FS Tell Me More about…Family Care Partnership - Spanish PDF 3/1/2011 Spanish
P-00088G Interdisciplinary Teams in Family Care Partnership PDF 3/1/2009 English
P-00088GH Interdisciplinary Teams in Family Care Partnership - Hmong PDF 3/1/2009 Hmong
P-00088GR Interdisciplinary Teams in Family Care Partnership - Russian PDF 3/1/2009 Russian
P-00088GS Interdisciplinary Teams in Family Care Partnership - Spanish PDF 3/1/2009 Spanish
P-00088H Tell Me More About Program of All-Inclusive Care for the Elderly (PACE) PDF 3/1/2011 English
P-00088HH Tell Me More about…Program of All-Inclusive Care for the Elderly (PACE) - Hmong PDF 3/1/2011 Hmong
P-00088HR Tell Me More About Program of All-Inclusive Care for the Elderly (PACE) - Russian PDF 3/1/2011 Russian
P-00088HS Tell Me More about…Program of All-Inclusive Care for the Elderly (PACE) - Spanish PDF 3/1/2011 Spanish
P-00088I Interdisciplinary Teams in Program of All-Inclusive Care for the Elderly (PACE) PDF 3/1/2009 English
P-00088IH Interdisciplinary Teams in Program of All-Inclusive Care for the Elderly (PACE) - Hmong PDF 3/1/2009 Hmong
P-00088IR Interdisciplinary Teams in Program of All-Inclusive Care for the Elderly (PACE) - Russian PDF 3/1/2009 Russian
P-00088IS Interdisciplinary Teams in Program of All-Inclusive Care for the Elderly (PACE) - Spanish PDF 3/1/2009 Spanish
P-00088J Key Differences between Family Care, Partnership, and PACE PDF 3/1/2011 English
P-00088JH Key Differences between Family Care, Partnership, and PACE - Hmong PDF 3/1/2011 Hmong
P-00088JR Key Differences between Family Care, Partnership, and PACE - Russian PDF 3/1/2011 Russian
P-00088JS Key Differences between Family Care, Partnership, and PACE - Spanish PDF 3/1/2011 Spanish
P-00088K What will Change? From the Medicaid Waiver Programs to IRIS PDF 3/1/2011 English
P-00088KH What will Change? From the Medicaid Waiver Programs to IRIS - Hmong PDF 3/1/2011 Hmong
P-00088KR What will Change? From the Medicaid Waiver Programs to IRIS - Russian PDF 3/1/2011 Russian
P-00088KS What will Change? From the Medicaid Waiver Programs to IRIS - Spanish PDF 3/1/2011 Spanish
P-00088L Tell Me More About Self-Directed Supports in Managed Care PDF 3/1/2009 English
P-00088LH Tell Me More About…Self-Directed Supports in Managed Care - Hmong PDF 3/1/2009 Hmong
P-00088LR Tell Me More About Self-Directed Supports in Managed Care - Russian PDF 3/1/2009 Russian
P-00088LS Tell Me More About…Self-Directed Supports in Managed Care - Spanish PDF 3/1/2009 Spanish
P-00088M Tell Me More About IRIS PDF 11/1/2009 English
P-00088MH Tell Me More about…IRIS - Hmong PDF 11/1/2009 Hmong
P-00088MR Tell Me More About IRIS - Russian PDF 11/1/2009 Russian
P-00088MS Tell Me More about…IRIS - Spanish PDF 11/1/2009 Spanish
P-00088N Key Questions: Highlighting Differences between options for self-direction in Family Care/Partnership/PACE and IRIS PDF 3/1/2011 English
P-00088NH Key Questions: Highlighting Differences between options for self-direction in Family Care/Partnership/PACE and IRIS - Hmong PDF 3/1/2011 Hmong
P-00088NR Key Questions: Highlighting Differences between options for self-direction in Family Care/Partnership/PACE and IRIS - Russian PDF 3/1/2011 Russian
P-00088NS Key Questions: Highlighting Differences between options for self-direction in Family Care/Partnership/PACE and IRIS - Spanish PDF 3/1/2011 Spanish
P-00088O Covered Services in Wisconsin's Long-Term Care Programs PDF 12/1/2011 English
P-00088OH Covered Services…in Wisconsin's Long-Term Care Programs - Hmong PDF 12/1/2011 Hmong
P-00088OR Covered Services in Wisconsin's Long-Term Care Programs - Russian PDF 12/1/2011 Russian
P-00088OS Covered Services…in Wisconsin's Long-Term Care Programs - Spanish PDF 12/1/2011 Spanish
P-00088P Family Care Benefit Packages: Nursing Home and Non-Nursing Home Level of Care PDF 3/1/2011 English
P-00088PH Family Care Benefit Packages: Nursing Home and Non-Nursing Home Level of Care - Hmong PDF 3/1/2011 Hmong
P-00088PR Family Care Benefit Packages: Nursing Home and Non-Nursing Home Level of Care - Russian PDF 3/1/2011 Russian
P-00088PS Family Care Benefit Packages: Nursing Home and Non-Nursing Home Level of Care - Spanish PDF 3/1/2011 Spanish
P-00088Q Non-Nursing Home Level of Care Benefit Options PDF 3/1/2009 English
P-00088QH Non-Nursing Home Level of Care Benefit Options - Hmong PDF 3/1/2009 Hmong
P-00088QR Non-Nursing Home Level of Care Benefit Options - Russian PDF 3/1/2009 Russian
P-00088QS Non-Nursing Home Level of Care Benefit Options - Spanish PDF 3/1/2009 Spanish
P-00088R What Will Change? From the Medicaid Waiver Programs to Managed Long-Term Care PDF 3/1/2009 English
P-00088RH What Will Change? From the Medicaid Waiver Programs to Managed Long-Term Care - Hmong PDF 3/1/2009 Hmong
P-00088RR What Will Change? From the Medicaid Waiver Programs to Managed Long-Term Care - Russian PDF 3/1/2009 Russian
P-00088RS What Will Change? From the Medicaid Waiver Programs to Managed Long-Term Care - Spanish PDF 3/1/2009 Spanish
P-23189 Being A Full Partner In Family Care PDF 1/1/2010 English
P-23189B Being a Full Partner In Family Care, Braille Paper 1/1/2010 Braille
P-23189H Being A Full Partner In Family Care, Hmong PDF 1/1/2010 Hmong
P-23189L Being A Full Partner In Family Care - LARGE PRINT PDF 1/1/2010 English
P-23189R Being A Full Partner In Family Care - Russian PDF 1/1/2010 Russian
P-23189S Being a Full Partner in Family Care - Spanish PDF 1/1/2010 Spanish