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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-16025AR Disqualification Consent Agreement, Arabic 07/2023 PDF Arabic No
F-16024CM FoodShare Notice of Disqualification, Chinese (Simplified) 07/2023 PDF Chinese (Simplified) No
F-16024 FoodShare Notice of Disqualification 07/2023 PDF English No
F-16024AR FoodShare Notice of Disqualification, Arabic 07/2023 PDF Arabic No
F-16024R FoodShare Notice of Disqualification, Russian 07/2023 PDF Russian No
F-16024H FoodShare Notice of Disqualification, Hmong 07/2023 PDF Hmong No
F-16024SO FoodShare Notice of Disqualification, Somali 07/2023 PDF Somali No
F-16024S FoodShare Notice of Disqualification, Spanish 07/2023 PDF Spanish No
F-01252 FoodShare Employment and Training (FSET) - Initial Appointment 07/2023 Word English No
F-01255 FoodShare Employment and Training (FSET) - Job Club Appointment 07/2023 Word English No
F-01257 FoodShare Employment and Training (FSET) - Workshop Appointment 07/2023 Word English No
F-01256 FoodShare Employment and Training (FSET) - Discuss FSET Participation 07/2023 Word English No
F-01254 FoodShare Employment and Training (FSET) - Employment Plan (EP) Appointment 07/2023 Word English No
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice 07/2023 Word English No
F-00685 Statement of Tribal Affiliation 06/2023 PDF English No
F-01542S Notification of Required Drug Testing, Spanish 06/2023 PDF Spanish No
F-01542 Notification of Required Drug Testing 06/2023 PDF English No
F-01542H Notification of Required Drug Testing, Hmong 06/2023 PDF Hmong No
F-10137H Medicaid Change Report, Hmong 06/2023 PDF Hmong No
F-10137S Medicaid Change Report, Spanish 06/2023 PDF Spanish No
F-10137DA Medicaid Change Report, Dari 06/2023 PDF Dari (Afghan Persian) No
F-10137 Medicaid Change Report 06/2023 PDF English No
F-10137PA Medicaid Change Report, Pashto 06/2023 PDF Pashto No
F-10129 Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application 06/2023 PDF English No
F-10129S Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Spanish 06/2023 PDF Spanish No

Glossary

 
Last revised February 20, 2026