COVID-19: Vaccinator Enrollment

Wisconsin COVID-19 Vaccine Program is continuing to enroll entities that wish to administer COVID-19 vaccine in Wisconsin. This page delineates the steps and other information needed to enroll in the program and get approved to administer COVID-19 vaccine in Wisconsin. To become a COVID-19 vaccinator, all organizations must have an approved Form A and Form B. To redistribute vaccine, all enrolled COVID-19 vaccinators must also have an approved Redistribution Form. See the general vaccination guidance page for steps to redistribute vaccine.

Updates  

Vaccinators may now host a COVID-19 vaccine clinic up to two consecutive days (48 hours) without needing to submit a separate provider agreement Form B, as long as the vaccine is not stored overnight at the new location. The clinic may also be held for another two days for the administration of the second dose in a two-dose series without needing a Form B.

Note: If vaccine is stored over night or if the vaccine clinic is held for three days in a row or more, a Form B is necessary for that location.

Useful links and resources

Steps to enroll

It is important that you complete every step in the enrollment process in order to ensure your submission is processed as quickly as possible. Please use Google Chrome when navigating the enrollment tool. Email the Wisconsin Department of Health Services (DHS) if you have any questions.

Jump to frequently asked questions about enrollment.

Step 1: Log in to the COVID-19 Vaccinator Enrollment Tool.

Log in to the COVID-19 Vaccinator Enrollment Tool using your Wisconsin Department of Administration (DOA)/Wisconsin Logon Management System username and password.

  • If you do not have a DOA/Wisconsin Logon, please register here.
    • Select Self-Registration. After you accept the user agreement and fill in your personal profile information, select “DHS Health Reports” under “Systems You Will Access.”
    • After your registration is complete, proceed to the enrollment tool.
  • If you have a DOA/Wisconsin Logon, then proceed to the enrollment tool and logon using your DOA/Wisconsin Logon username and password.

Step 2: Generate your forms.

Note: Once information is entered and site type is chosen, you may not go back to change them.

  • Enter information into the COVID-19 Vaccinator Enrollment Tool.
  • Scroll to the bottom of the page and select “Generate Forms,” which will generate forms specifically for your organization.
    • Your organization's legal name and a reference number will be pre-populated on the forms (located at the bottom of each generated form).
    • You can have your vaccine sites use this information to ensure they are using your organization-specific forms.

Step 3: Complete and sign your forms.

Note: All signatures must be present on a form before submission. Instruction is provided within the forms by hovering over the blue bars in the form.

  • Each unique legal organization must complete a Form A.
  • Complete a Form B for each physical address where you will store or administer COVID-19 vaccine, with certain exceptions. Please see these provider registration scenarios to see what forms are required for different vaccination clinics. If you have questions about whether your organization requires additional Form B submissions, please email DHS.
  • If your organization may need to move vaccine to another organization, or to another Form B location within your own organization, you must complete a Redistribution Form. See the general vaccination guidance page for steps to redistribute vaccine. This form should match your organization’s Form A in the following fields:
    • Organization Name
    • Medical Director/Chief Medical Officer
    • Chief Executive Officer (CEO) or Chief Financial Officer (CFO)

Step 4: Submit all your forms.

Note: You may submit your organization's forms from any DOA/Wisconsin Logon. Only submit the completed forms that were specifically generated for your organization with the reference number in Step 2 above. The reference number is listed at the bottom right of your generated forms.

  • Find “Submit Forms” at the top left of your web browser.
  • Upload your completed and signed forms to their corresponding fields. Please remember to sign and date your forms.
  • Scroll to the bottom of the page and select the “Upload Files” button.
  • If you need to change your information after submitting do so via the Wisconsin Immunization Registry. Any information that needs to be changed outside of WIR can be done by contacting dhscovidvaccinator@dhs.wisconsin.gov.

Step 5: Respond to questions about your submission, at all stages of registration.

  • At different stages of registration, DHS may contact you to ask questions about your submission, correct errors, or provide instructions on next steps. Please respond to this outreach immediately so that DHS can continue processing your registration.
  • This step may occur after your organization has been approved to receive vaccine.

Step 6: The primary contact will receive an email from DHS with next steps for your organization.

Once your information is verified and your WIR account is configured, the primary contact listed on the Form B will receive an email from DHS with next steps for your organization.

Make sure your staff is properly trained with the required trainings listed on the vaccinator guidance webpage.

Enrollment Questions and Answers

 General enrollment

Q: How do I enroll?

A: Please follow the steps outlined in the Steps to Enroll tab above. Once you generate your forms in the enrollment tool, there is hover text with additional details located in the blue bars of your forms. When you hover your mouse over some of the blue section bars, text boxes will pop up with further instructions.

Q: Should I enroll in the COVID-19 Vaccine Program if my organization is already a Vaccines for Children (VFC) and/or Vaccines for Adults (VFA) provider?

A: Yes, you need to enroll. This is a new program and all providers need to sign the CDC COVID-19 vaccine agreement regardless of VFC/VFA status.

Q: Is there a certain web browser I must use for the enrollment tool?

A: Yes, please use Google Chrome. Do not use Internet Explorer or Microsoft Edge. If you do submit your forms in the wrong browser you may get an error. If this happens, please regenerate the forms and resubmit them in Google Chrome.

Q: Where can I find additional instructions to complete the enrollment forms?

A: Additional instructions are provided as hover text over the blue bars within each of the forms. There are guides on how to fill out all provider enrollment forms in the COVID-19 Vaccine Enrollment Tool. These go over examples and expand on what is needed in each section of the forms.

Q: How do I electronically sign my agreement?

A: Complete the following steps:

  1. Use Google Chrome to download the forms.

  2. Save the forms to your desktop.

  3. Complete your forms electronically in the updated version of Adobe (not in a web browser such as Internet Explorer). If you use an earlier version it will let you sign and complete your form, but the PDF produced from it may be too large to be accepted by the enrollment tool.

  4. Follow the instructions found in the enrollment tool to upload your forms and complete your signature.

Q: How do I know what the next steps are after I submit the enrollment forms?

A: Once the forms have been successfully submitted they will go through a review process and be matched to an existing WIR account. Throughout this process the provider enrollment group will be reaching out to correct forms, ask questions about your forms, and set you up with a WIR account if none exist for you. You will also receive an email with next steps, including a training attestation and readiness checklist that need to be filled out and returned to be considered fully enrolled.

Q: Should Vaccines for Children (VFC) providers enroll in the CDC COVID-19 Vaccination Program?

A: Yes, as Emergency Use Authorization of COVID-19 vaccine products expand to include adolescents and children, providers enrolled in the Vaccines for Children (VFC) Program are well situated to enroll in the CDC COVID-19 Vaccination Program to ensure equitable access to COVID-19 vaccination services. VFC providers have direct access to the younger patient population and are familiar with vaccine administration and federal vaccine programs.

Though the VFC and COVID-19 Vaccination programs are both federal government programs, they each have distinct requirements based on the associated funding legislation. For this reason, the provider agreements remain separate, and VFC providers must sign and adhere to the requirements of the CDC COVID-19 Vaccination Program Provider Agreement in order to receive and administer COVID-19 vaccines.

Review the VFC and COVID-19 Vaccination Program comparison table to assist in understanding the differences in the programs’ requirements.

 Filling out forms

Q: How many Form A's need to be submitted?

A: Only one Form A needs to be submitted for the entire organization. However, a Form A may be submitted for any level of the organization from the clinic all the way up to the corporate level.

Q: Which sites in my organization need to fill out the Form B?

A: Complete one Form B for each site that will be administering COVID-19 vaccine.

  • Two-day vaccine clinics (less than 48 hours) and their second dose clinics one month later do not need a Form B. However, if vaccine is stored over night or held for more than two consecutive days, a Form B is necessary for that location.

  • There may be special conditions in which single- or two-day vaccine clinics need a Form B. These provider registration scenarios determine whether an additional Form B is required for a vaccination clinic.

  • If you are unsure whether you need a Form B, you can preemptively fill out a Form B or email dhscovidvaccinator@dhs.wisconsin.gov for clarification.

Q: Is there a limit to how many Form B’s can be filled out for every Form A?

A: No, there is no limit. If you are going to submit multiple Form B’s for one Form A, please create a different organization location name for each clinic’s Form B so they can be matched to the correct WIR site. All of the forms will still need to have the same reference number and organization's legal name listed at the bottom of their Form A.

Q: What if sites begin submitting Form B’s before the organization’s Form A is submitted?

A: Form B’s will not be registered until the corresponding Form A is verified. Once both sections are submitted and verified, the organization and sites will begin the WIR matching process.

Q: Which providers should be included on my Form B?

A: Any provider licensed in Wisconsin who has prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine should be included on your Form B’s. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others.

Q: If additional sites are identified after my original submission, can I submit additional Form B’s at a later date?

A: Yes, please make sure your organization name and reference number on the new Form B’s match your originally submitted forms.

Q: What if I don’t know my IIS identifier?

A: Please include either:

WIR Organization ID Identifier

  • Your Wisconsin Immunization Registry (WIR) Org ID. If you do not know your WIR Org ID, you can use the following steps to find your WIR Org ID, if you have one.

  1. Find a staff member from your organization that has access to WIR as an IR Administrator. Any staff member that is an IR Administrator can find your WIR Org ID by following these steps.

  2. Navigate to manage access and select Edit Organization.

  3. From the list of organizations click the link for the correct location.

  4. The Edit Organization page loads.

  5. You will find a number next to the Org Id. This number is also your IIS Identifier.

  • If you cannot find or do not have your WIR Org ID, you can use your VFC PIN.

  • If you do not have a WIR Org ID nor a VFC PIN, then please submit your forms without them.

 Correcting and submitting forms

Q: I have signed the forms incorrectly and when I submitted it, I got an error. I fixed the signature (per the Signature Instructions), and the enrollment tool still will not accept my forms. What should be done?

A: Unfortunately, you will need to generate a new version of the forms, refill it out, sign it correctly, and then resubmit it to the enrollment tool.

Q: What if I need to update information on the forms?

A: Please submit an email request to change information to your forms to dhscovidvaccinator@dhs.wisconsin.gov. You must include the location or organization name listed on your original forms in the subject line. Then include what information you need changed in the body of the email.

Q: When will I know if my forms were submitted correctly?

A: After your forms have been submitted, you should receive a confirmation screen which will indicate that your forms have been submitted correctly.

Q: How do I add additional health care providers (licensed clinicians) to my Form B that has already been enrolled?

A: Please email DHSCovidVaccinator@wi.gov with the additional providers’ information including: their full name, clinical title, and license number (for example, 12345-33). In the subject line please add, “Additional Providers for Form B.”

As a reminder, all licensed health care providers who have prescribing authority or who will have oversight of the handling or administration of COVID-19 vaccine must be listed on the site’s Form B. This includes titles such as MD, DO, NP, DPM, PA, RPh, and more. Please do not list providers who will be immunizing without prescribing authority, such as EMT, RN, LPN, paramedic, and others. Only licensed providers with direct involvement with COVID-19 vaccine should be listed.

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Last Revised: August 26, 2021

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