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Data Collection (Forms) Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions.

When you are searching for a form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-20582 Instructions, Spanish DMS Spanish 03/2023 PDF No
F-01721 Instructions-Calculating CLTS Foster Care Room and Board Expenses DMS English 03/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records DMS English 02/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish DMS Spanish 02/2017 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 04/2023 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong DMS Hmong 04/2023 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish DMS Spanish 04/2023 PDF No
F-01234 Instructions: Explanation of Medical Benefits DMS English 04/2018 PDF No
F-16030 Instructions: FoodShare Wisconsin Overpayment Calculator DMS English 01/2018 PDF No
F-22540 Instructions: Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs OPIB English 05/2019 PDF No
F-10110 Instructions: Medicaid/BadgerCare Plus Eligibility Certification DMS English 01/2018 HTML No
F-02074 Instructions: Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF No
F-11133 Instructions: Personal Care Screening Tool (PCST) DMS English 08/2017 PDF No
F-11010 Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2018 PDF No
F-11008 Instructions: Prior Authorization / Therapy Attachment (PA/TA) DMS English 05/2019 PDF No
F-01248 Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF No
F-01012 Instructions: Reimbursement Request for a PASRR Level I Screen DMS English 08/2017 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business DMS English 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Chinese Mandarin DMS Chinese Mandarin 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Hmong DMS Hmong 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Spanish DMS Spanish 06/2019 PDF No
F-22637 Interagency Notification -Termination of Community Waiver Participation DMS English 03/2017 PDF No
F-10142 Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant DMS English 07/2008 PDF No
F-42010 Interjurisdictional Tuberculosis Notification DPH English 03/2003 PDF No
F-42011 Interjurisdictional Tuberculosis Notification - Follow-up DPH English 03/2003 PDF No
F-47463D Intermediate Operational Plan Components DPH English 06/2012 PDF No
F-47463C Intermediate Technician Operational Plan Components DPH English 06/2012 PDF No
F-03010 Intoxicated Driver Program Assessor Training Application DCTS English 03/2022 HTML No
F-01761 Intoxicated Driver Program Self-Evaluation DCTS English 09/2016 Word No
F-20891 Intoxicated Driver Program Supplemental Funding Request DCTS English 10/2022 Word No
F-02961 Introduction to Community Recovery Services Presentation Evaluation Survey DCTS English 02/2022 HTML No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization DPH English 05/2023 HTML No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Arabic DPH Arabic 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Chinese (Mandarin) DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Hmong DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Laotian DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Large Print DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Russian DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Serbo-Croatian DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Somali DPH English 05/2023 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization, Spanish DPH English 05/2023 Word No
F-02021 IRIS - Certified Public Accountant (CPA) Audit Checklist DMS English 02/2017 Word No
F-01415 IRIS Adult Family Home Taxable Income Information DMS English 05/2023 Word No
F-01210A IRIS Budget Amendment Provider Quote Comparison DMS English 02/2017 Word No
F-01210 IRIS Budget Amendment Request DMS English 12/2017 Word No
F-01209 IRIS Certification Acknowledgment DMS English 02/2017 Word No
F-01549 IRIS Certification Designation of Confidential and Proprietary Information DMS English 02/2017 Word No
F-01563 IRIS Consultant Agency (ICA) Provider Change Letter DMS English 05/2023 Word No
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist DMS English 08/2020 Word No
Last revised April 13, 2023