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EMS: Funding Assistance Program Forms—Frequently Asked Questions

You are required to submit certain forms as part of the application process for the Funding Assistance Program (FAP). We’ve gathered common questions about forms related to the Wisconsin Department of Administration (DOA) and Internal Revenue Service.

Expand a section to learn more.

All forms

You must complete these forms to get FAP payments:

  • DOA-6460
  • DOA-6457
  • DOA-6458
  • W-9

Our payment system requires that all services are set up as “suppliers” with the State of Wisconsin. These forms collect the information needed for this process. They ensure correct and timely payments.

You only need to fill out the forms that apply to your service. The following list explains each form:

  • DOA-6460—This form is for new suppliers. Use it if another state agency has paid you before. It’s likely that they are already in the Wisconsin financial system.
  • DOA-6457—This form is for established suppliers, such as those who’ve received FAP funding and public agencies. Use it for address updates. List the old address in Section 2, and the new address in Section 3.
  • DOA-6458—This form is for established suppliers who are changing their names.
    • If you are part of a public agency in a city, town, county, or tribal nation, your legal business name should be the public agency name. Examples include Milwaukee County, City of West Bend, and Village of Argyle.
    • To confirm your address for the municipality treasury, fill in Section 3. Leave Section 2 blank.
  • W-9—This form is for all suppliers. You must submit it every year. This ensures that we are paying the correct supplier. All suppliers connect to an employer identification number (EIN). The W-9 confirms these numbers and tells us if there are changes in a service’s tax classification.

Note: Submit all required forms during the open FAP application period. If you don’t submit your forms, you may give up your chance to get funding.

The service director should be the main contact between the EMS (Emergency Medical Services) provider and Wisconsin Department of Health Services (DHS). We suggest that the service director works with either the service provider or public agency leadership to help fill out the DOA forms. Administrative staff may complete forms, as long as the service director oversees the process.

This guidance comes from Wis. Admin. Code § DHS 110.46, License Duration and Application for Renewal License.

Submit all forms electronically as PDFs to DHSFAP@dhs.wisconsin.gov.

You may get a notice to fill out DOA-6457 or DOA-6458 if your FAP application and the information in the State of Wisconsin payment system don’t match. Make sure you list the correct name and address that’s linked to your EIN.

Common errors include:

  • A change to the “doing business as” name while keeping the same legal name.
  • Not including a post office box used for mailing.

DOA-6460, DOA-6457, and DOA-6458 all ask for EINs, DUNS, and UEI numbers:

  • EIN—Employer Identification Number. This is a tax identification number that you use to report income to the Internal Revenue Service. You can find your service EIN through your service provider or public agency leadership. It’s also on the Internal Revenue Service website.
  • DUNS—Data Universal Number System. This is a number system used to find places that have received government funding. The federal government is shifting from DUNS to UEI. You can find your DUNS or UEI through your service provider or public agency leadership.
  • UEI—Unique Entity Identifier. You can find your UEI by going to grants.gov. Follow these steps:
  1. Log in to your grants.gov account.
  2. Select My Account (top).
  3. Select Manage Profiles.
  4. Find the UEI for each registered profile under the UEI column header.

Note: If you don’t have a DUNS or UEI, you can leave this section blank.

DOA-6457

The Supplier ID is a unique identifier. DOA assigns it to track payments from the State of Wisconsin.

There are two ways to find your existing Supplier ID:

  • If you received a check from us before, the Supplier ID is at the top of the check skirt attached to the check.
  • If you received payments as an Automated Clearing House, the Supplier ID is in the remittance email. You should have received this email to let you know about the payment.

The number/amount refers to the last time your service got FAP funds. Contact DHSFAP@dhs.wisconsin.gov for this number.

We ask these questions to know if your service is in debt and has collected debt assistance from DOR. If your service or public agency has financial sanction from DOR, it might impact the funding you get.

Contact your service provider or public agency leadership for help with these DOR questions.

Last revised April 3, 2023