Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing from this site. If a form is not available electronically, you will be provided instructions for requesting a paper copy. If you are searching for a form number that does not start with the letter "F," just enter the number you have available and you will get a better search result. Example, looking for DDE-2539? Enter "2539" in the Search Forms field below.

The Division of Health Care Access and Accountability (DHCAA) and Division of Long Term Care (DLTC) have combined into the Division of Medicaid Services (DMS). When searching for forms by Division, please use the new acronym.

Assigned Number Title Other Location Language
F-21276 DCTS Annual Grant/Contract Application English
F-44746 Farmers Market Nutrition Program (FMNP) - Site Observation Worksheet English
F-21276A DCTS Coordinated Services Teams (CST) Grant / Contract Application Summary English
F-82009II WIC Confidential Information Release Authorization English
F-44819 Farmers Market Nutrition Program (FMNP) - Application for Farmstands English
F-01736 Vaccine Return - Request for Authorization to Return English
F-01601 DCTS Summary Line Item Budget English
F-02205 EMS Instructor II Evaluation English
F-44757 WIC Farmer's Market Contract For Farmers English
F-44621 WIC Stock Price Survey English
F-01644 Parents Who Host, Lose The Most Application English
F-44727 WIC Vendor Training Proof English
F-00164 Civil Rights Compliance Plan English
F-00165 Civil Rights Compliance Letter of Assurance English
F-44755 WIC Farmers' Market Nutrition Program English
F-44160A WIC Plastic Cover for WIC ID Folder English
F-01367 Wisconsin WIC Referral/Communication to CYSHCN Regional Center English
F-00193 Pediatric Referral / Communication Wisconsin WIC Program English
F-40085 WIC Program Notice of Ineligibility English
F-02026 Ethnicity and Race Selection English
F-40041 Certification & Food Package Pick-Up English
F-40108 Retail Vendor Application Amendment Women, Infant, and Children (WIC) English
F-40059 The Emergency Food Assistance Program (TEFAP) Eligibility Certification English
F-01804 Appointment Results Wisconsin WIC Program English
F-40044 Participant Agreement, Rights & Responsibilities English
F-40019 Affirmation of Identity, Residency, and/or Income English
F-44024A WIC Prescriptions / Clinical Data - Pregnant, Breastfeeding and Non-Breastfeeding Postpartum Women English
F-44322 Vendor / Participant Complaint - Wisconsin Women, Infant, and Children (WIC) Program English
F-40093 Annual ROSIE User Security and Confidentiality Agreement English
F-02066 Abbreviated Denial Corrective Action Plan (CAP) Wisconsin WIC Program English
F-40053 Farmers' Market Nutrition Program (FMNP) - Verification of Participation in Farmer Training English
F-01579 Wisconsin eWIC Cash Register System Survey English
F-40028 Participant Determination Letter English
F-44161A WIC Cardholder Rights and Responsibilities English
F-01763 TEFAP Review Findings for Food Pantries, Soup Kitchens and Shelters English
F-40062 The Emergency Food Assistance Program TEFAP and CSFP Commodity Loss Report English
F-44323 WIC Stock Price Survey – Pharmacy Only English
F-40096 WIC Program Repayment Agreement English
F-02040 WIC Program Notice of Categorical Ineligibility English
F-44158 WIC Application Brochure/Postcard English
F-40034 Wisconsin WIC Program Retail Vendor Initial Authorization Application and Instructions for Completing English
F-01764 TEFAP Food Pantry Review English
F-40063 The Emergency Food Assistance Program (TEFAP) Commodities Complaint English
F-44444 WIC Vendor Supply Order English
F-00005 Senior FMNP Agency Application to Participate English
F-44161 WIC Rights and Responsibilities English
F-04003 Vendor Monitoring Worksheet - Wisconsin WIC Program English
F-40036 Wisconsin Women, Infant, and Children (WIC) Program Vendor Agreement English
F-01765 TEFAP Food Pantry Self-Assessment Tool English
F-40064 Transfer of The Emergency Food Assistance Program (TEFAP) Commodities between EFO's English

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Last Revised: July 28, 2017