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Wisconsin Department of Health Services

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Information about Division of Quality Assurance (DQA)

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Corporate Guardianships - Forms

Introduction | Rules & Regulations | Forms | Providers | Contacts


Questions concerning Wisconsin corporate guardianships, call or E-mail Dinh Tran, (608) 266-6646.

F-60820: Corporate Guardian Status Application (Word, 150 KB)  Note: You can print the completed document but you cannot save it.

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.

The Caregiver Law, under s.50.065, Stats., requires two types of caregiver background checks:

  1. Those completed by employers on their employees and contractors.
  2. Those completed by the Division of Quality Assurance (DQA) on license applicants/license holders and/or some principal officers of DQA-regulated facilities.

Beginning April 2, 2013, the Division of Quality Assurance began an automated Caregiver Background Check Process - A caregiver background check (CBC) is completed on all new and/or existing Guardianship Program Managers.

Review information for Licensee Applicants/License Holder Background Checks found on the Caregiver Background Check Process web page for the completion of the Background Information Disclosure (BID) form and Appendix. Complete either the Online Caregiver Background Check (CBC) process or submit a paper application.

 

Last Updated: June 25, 2014