All Income Maintenance (IM) Forms and Worksheets

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

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Assigned number	Title	Release date Sort ascending	File type	Language	Available to order
F-16015	Notice of Approval of Benefits/Positive Change in Benefits	07/2020	Word	English	No
F-10146A	Employer Verification of Earnings: Proof of Employment	06/2020	Word	English	No
F-00639	Agency Data Security Staff User Agreement	02/2020	PDF	English	No
F-22565	Authorization for Recoupment Caretaker Supplement (CTS)	09/2019	PDF	English	No
F-22565	Authorization for Recoupment Caretaker Supplement	09/2019	Word	English	No
F-10185	BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication	09/2019	Word	English	No
F-10184	BadgerCare Plus Former Foster Care Youth (FFCY)	09/2019	Word	English	No
F-10093	Medicaid and BadgerCare Plus Overpayment Notice	09/2019	PDF	English	No
F-10093	Wisconsin Medicaid and BadgerCare Plus Overpayment Notice	09/2019	Word	English	No
F-10093S	Medicaid and BadgerCare Plus Overpayment Notice, Spanish	09/2019	Word	Spanish	No
F-10093S	Medicaid and BadgerCare Overpayment Notice, Spanish	09/2019	PDF	Spanish	No
F-00233S	Renewal Summary Letter (Spanish)	08/2019	Word	Spanish	No
F-00233	Renewal Summary Letter	08/2019	Word	English	No
F-00233H	Renewal Summary Letter (Hmong)	08/2019	Word	Hmong	No
F-00219	Self-Employment Income Report: Farm Business	06/2019	PDF	English	No
F-00219S	Self-Employment Income Report: Farm Business, Spanish	06/2019	PDF	Spanish	No
F-00219H	Self-Employment Income Report: Farm Business, Hmong	06/2019	PDF	Hmong	No
F-00219AS	Self-Employment Income Report: Farm Business Instructions, Spanish	06/2019	PDF	Spanish	No
F-00219CM	Self-Employment Income Report: Farm Business, Chinese (Simplified)	06/2019	PDF	Chinese (Simplified)	No
F-00219AH	Self-Employment Income Report: Farm Business Instructions, Hmong	06/2019	PDF	Hmong	No
F-00219A	Self-Employment Income Report: Farm Business Instructions	06/2019	PDF	English	No
F-00219ACM	Self-Employment Income Report: Farm Business Instructions, Chinese (Simplified)	06/2019	PDF	Chinese (Simplified)	No
F-00107	Self-Employment Income Report	06/2019	PDF	English	No
F-00107	Instructions, Self-Employment Income Report	06/2019	PDF	English	No
F-00107	Instructions, Self-Employment Income Report, Hmong	06/2019	PDF	Hmong	No

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