Skip to main content
Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

HTTPS

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

All Income Maintenance (IM) Forms

Below is a list of all Income Maintenance (IM) forms. 

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-16004 Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits DMS English 04/2024 PDF No
F-16004H Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Hmong DMS Hmong 04/2024 PDF No
F-16004R Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Russian DMS Russian 04/2024 PDF No
F-16004S Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Spanish DMS Spanish 04/2024 PDF No
F-16038 Administrative Disqualification Hearing Notice DMS English 08/2023 PDF No
F-16038AR Administrative Disqualification Hearing Notice, Arabic DMS Arabic 08/2023 PDF No
F-16038CM Administrative Disqualification Hearing Notice, Chinese DMS Chinese Mandarin 08/2023 PDF No
F-16038G Administrative Disqualification Hearing Notice, German DMS German 08/2023 PDF No
F-16038H Administrative Disqualification Hearing Notice, Hmong DMS Hmong 08/2023 PDF No
F-16038L Administrative Disqualification Hearing Notice, Laotian DMS Laotian 08/2023 PDF No
F-16038R Administrative Disqualification Hearing Notice, Russian DMS Russian 08/2023 PDF No
F-16038SO Administrative Disqualification Hearing Notice, Somali DMS Somali 08/2023 PDF No
F-16038S Administrative Disqualification Hearing Notice, Spanish DMS Spanish 08/2023 PDF No
F-01315 AFDC-Related Determination Worksheet DMS English 07/2014 PDF No
F-00639 Agency Data Security Staff User Agreement DMS English 02/2020 PDF No
F-10172 Agency Response to the State Quality Assurance (QA) Medicaid Finding DMS English 07/2008 PDF No
F-10126B Appoint, Change, or Remove an Authorized Representative: Organization DMS English 03/2024 PDF No
F-10126BAR Appoint, Change, or Remove an Authorized Representative: Organization, Arabic DMS Arabic 03/2024 PDF No
F-10126BCM Appoint, Change, or Remove an Authorized Representative: Organization, Chinese Mandarin DMS Chinese Mandarin 03/2024 PDF No
F-10126BDA Appoint, Change, or Remove an Authorized Representative: Organization, Dari DMS Dari 03/2024 PDF No
F-10126BG Appoint, Change, or Remove an Authorized Representative: Organization, German DMS German 03/2024 PDF No
F-10126BH Appoint, Change, or Remove an Authorized Representative: Organization, Hmong DMS Hmong 03/2024 PDF No
F-10126BL Appoint, Change, or Remove an Authorized Representative: Organization, Laotian DMS Laotian 03/2024 PDF No
F-10126BPA Appoint, Change, or Remove an Authorized Representative: Organization, Pashto DMS Pashto 03/2024 PDF No
F-10126BR Appoint, Change, or Remove an Authorized Representative: Organization, Russian DMS Russian 03/2024 PDF No
F-10126BSO Appoint, Change, or Remove an Authorized Representative: Organization, Somali DMS Somali 03/2024 PDF No
F-10126BS Appoint, Change, or Remove an Authorized Representative: Organization, Spanish DMS Spanish 03/2024 PDF No
F-10126A Appoint, Change, or Remove an Authorized Representative: Person DMS English 03/2024 PDF No
F-10126AAR Appoint, Change, or Remove an Authorized Representative: Person, Arabic DMS Arabic 03/2024 PDF No
F-10126ACM Appoint, Change, or Remove an Authorized Representative: Person, Chinese DMS Chinese Mandarin 03/2024 PDF No
F-10126ADA Appoint, Change, or Remove an Authorized Representative: Person, Dari DMS Dari 03/2024 PDF No
F-10126AG Appoint, Change, or Remove an Authorized Representative: Person, German DMS German 03/2024 PDF No
F-10126AH Appoint, Change, or Remove an Authorized Representative: Person, Hmong DMS Hmong 03/2024 PDF No
F-10126AL Appoint, Change, or Remove an Authorized Representative: Person, Laotian DMS Laotian 03/2024 PDF No
F-10126APA Appoint, Change, or Remove an Authorized Representative: Person, Pashto DMS Pashto 03/2024 PDF No
F-10126AR Appoint, Change, or Remove an Authorized Representative: Person, Russian DMS Russian 03/2024 PDF No
F-10126ASO Appoint, Change, or Remove an Authorized Representative: Person, Somali DMS Somali 03/2024 PDF No
F-10126AS Appoint, Change, or Remove an Authorized Representative: Person, Spanish DMS Spanish 03/2024 PDF No
F-22565 Authorization for Recoupment Caretaker Supplement DMS English 09/2019 Word No
F-22565 Authorization for Recoupment Caretaker Supplement (CTS) DMS English 09/2019 PDF No
F-22564 Authorization for Retroactive Caretaker Supplement (CTS) DMS English 07/2008 PDF No
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB) DMS English 03/2022 PDF No
F-14014H Authorization to Disclose Information to Disability Determination Bureau (DDB), Hmong DMS Hmong 03/2022 PDF No
F-14014S Authorization to Disclose Information to Disability Determination Bureau (DDB), Spanish DMS Spanish 03/2022 PDF No
F-00101 Authorization to Request Birth Records DMS English 06/2019 Word No
F-10081 BadgerCare Plus - Express Enrollment for Pregnant Women Application DMS English 02/2014 PDF Yes
F-10081A BadgerCare Plus - Express Enrollment for Pregnant Women Application Instructions DMS English 02/2024 PDF No
F-10115 BadgerCare Plus / Medicaid Health Insurance Information DMS English 01/2011 PDF No
F-10115S BadgerCare Plus / Medicaid Health Insurance Information, Spanish DMS Spanish 01/2011 PDF No
F-10182 BadgerCare Plus Application Packet DMS English 04/2024 PDF Yes
Last revised January 24, 2023