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All Income Maintenance (IM) Forms and Worksheets

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

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

Assigned number Title Release date File type Language Available to order
F-16066SO FoodShare Wisconsin Income Change Report, Somali 10/2025 PDF Somali No
F-10076AH SeniorCare Application Instructions, Hmong 10/2025 PDF Hmong No
F-10076AS SeniorCare Application Instructions, Spanish 10/2025 PDF Spanish No
F-16030A FoodShare Wisconsin Overpayment Calculator 10/2025 Excel English No
F-10076AL SeniorCare Application Instructions, Laotian 10/2025 PDF Lao No
F-13023 Member/Employer Electronic Funds Transfer for Medicaid Purchase Plan Premiums 03/2025 PDF English No
N/A Telephonic Signature Prompts 1-17 Hmong 12/2024 PDF Hmong No
N/A Telephonic Signature Prompts 1-17 Spanish 12/2024 PDF Spanish No
F-00330R Request for Replacement FoodShare and/or Summer EBT Benefits, Russian 10/2024 PDF Russian No
F-10075S Wisconsin Well Woman Medicaid Application and Renewal, Spanish 10/2024 PDF Spanish No
F-00330G Request for Replacement FoodShare and/or Summer EBT Benefits, German 10/2024 PDF German No
F-00330AR Request for Replacement FoodShare and/or Summer EBT Benefits, Arabic 10/2024 PDF Arabic No
F-00330H Request for Replacement FoodShare and/or Summer EBT Benefits, Hmong 10/2024 PDF Hmong No
F-00330CM Request for Replacement FoodShare and/or Summer EBT Benefits, Chinese (Simplified) 10/2024 PDF Chinese (Simplified) No
F-00330L Request for Replacement FoodShare and/or Summer EBT Benefits, Laotian 10/2024 PDF Lao No
F-00330SO Request for Replacement FoodShare and/or Summer EBT Benefits, Somali 10/2024 PDF Somali No
F-00330S Request for Replacement FoodShare and/or Summer EBT Benefits, Spanish 10/2024 PDF Spanish No
F-10075 Wisconsin Well Woman Medicaid Application and Renewal 10/2024 PDF English Yes
F-00330 Request for Replacement FoodShare and/or Summer EBT Benefits 10/2024 PDF English No
F-16076 FoodShare Six-Month Report 10/2024 Word English No
F-16076S FoodShare Six-Month Report, Spanish 10/2024 Word Spanish No
F-16076H FoodShare Six-Month Report, Hmong 10/2024 Word Hmong No
F-10130 Medicaid Presumptive Disability 07/2024 PDF English No
F-13026S Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums, Spanish 05/2024 PDF Spanish No
F-13026 Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums 05/2024 PDF English No

Glossary

 
Last revised February 20, 2026