Corporate Guardianships -
Forms
Introduction | Rules_&_Regulations
| Forms | Providers | Contacts
Questions concerning Wisconsin corporate guardianships,
call Dinh Tran, (608) 266-6646, or E-mail the Division
of Quality Assurance.
F-60820: Corporate Guardian
Status Application (PDF, 24 KB) - Fillable
online - select the first
field to begin typing. Tab from field to field. You can print this
completed document but you cannot save it.
The Caregiver Law, under s.50.065, Stats., requires two types of
caregiver background checks:
- Those completed by employers on their employees and contractors
- Those completed by the Division of Quality Assurance (DQA) on license
applicants/license holders and/or some principal officers of DQA-regulated
facilities.
DQA will conduct background checks for those individuals
who apply for regulatory approval as Guardianship Program Managers.
Guardianship Program Managers must submit the following documents:
- Complete a Background
Information Disclosure (BID) form, F82064 (PDF,
30 KB).
- Complete a Background
Information Disclosure Appendix form, F82069 (PDF,
31 KB).
- Include a $10.00 processing fee for each person, payable to
"Division of Quality Assurance."
- Submit all forms with appropriate fee to:
Entity Background Checks
Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969
You must also file Articles of
Incorporation (Nonstock Corporation) (PDF, 87 KB)
with the Wisconsin Department of Financial Institutions
(exit DHS) before
submitting form F-60820.
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Last Updated: July 29, 2011
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