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 Sort ascending	File type	Language	Available to order
F-13024	Medicaid Purchase Plan Premium - Employer Wage Withholding	01/2026	PDF	English	No
DMS-1004	2026 FoodShare Management Evaluation Review (MER) Customer Survey, English	01/2026	HTML	English	No
DMS-1005	2026 Management Evaluation Review (MER) Income Maintenance (IM) Staff Survey	01/2026	HTML	English	No
DMS-1006	2026 Management Evaluation Review (MER) Advocate Survey	01/2026	HTML	English	No
DMS-1003i	FoodShare Trafficking Claim Overpayment Worksheet Instructions	01/2026	PDF	English	No
DMS-1003	FoodShare Trafficking Claim Overpayment Worksheet	01/2026	Word	English	No
F-00476A	CARES Automated Systems Access Request Instructions	12/2025	PDF	English	No
F-00476	CARES Automated Systems Access Request	12/2025	PDF	English	No
F-16104S	Customer Experience Survey, Spanish	12/2025	PDF	Spanish	No
F-16104	Customer Experience Survey	12/2025	PDF	English	Yes
F-16104H	Customer Experience Survey, Hmong	12/2025	PDF	Hmong	No
F-00332	Medicaid Purchase Plan Premium Information / Payment	10/2025	PDF	English	No
F-00332S	Medicaid Purchase Plan Premium Information / Payment, Spanish	10/2025	PDF	Spanish	No
F-01318	Medicaid Purchase Plan (MAPP) Medicaid and Remedial Expenses (MRE) Worksheet	10/2025	PDF	English	No
F-01317	Medicaid Purchase Plan (MAPP) Impairment Related Work Expense (IRWE) Worksheet	10/2025	PDF	English	No
F-10076AH	SeniorCare Application Instructions, Hmong	10/2025	PDF	Hmong	No
F-16066S	FoodShare Wisconsin Income Change Report, Spanish	10/2025	PDF	Spanish	No
F-16066R	FoodShare Wisconsin Income Change Report, Russian	10/2025	PDF	Russian	No
F-16066SO	FoodShare Wisconsin Income Change Report, Somali	10/2025	PDF	Somali	No
F-16066G	FoodShare Wisconsin Income Change Report, German	10/2025	PDF	German	No
F-16066	FoodShare Wisconsin Income Change Report	10/2025	PDF	English	No
F-10076AS	SeniorCare Application Instructions, Spanish	10/2025	PDF	Spanish	No
F-16066BU	FoodShare Wisconsin Income Change Report, Burmese	10/2025	PDF	Burmese	No
F-16066L	FoodShare Wisconsin Income Change Report, Laotian	10/2025	PDF	Lao	No
F-16066H	FoodShare Wisconsin Income Change Report, Hmong	10/2025	PDF	Hmong	No

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