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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-02410 Voluntary Property Checklist for Child Care Providers DPH 08/2022 HTML No
F-02410 Voluntary Property Checklist for Child Care Providers DPH English 04/2023 PDF No
F-02410H Voluntary Property Checklist for Child Care Providers, Hmong DPH Hmong 04/2023 PDF No
F-02410S Voluntary Property Checklist for Child Care Providers, Spanish DPH Spanish 04/2023 PDF No
F-02879 Vulnerable/High Risk Determination - IRIS Program DMS English 09/2021 Word No
F-16039 Waiver of Administrative Disqualification Hearing DMS English 07/2023 PDF No
F-16039AR Waiver of Administrative Disqualification Hearing, Arabic DMS Arabic 07/2023 PDF No
F-16039CM Waiver of Administrative Disqualification Hearing, Chinese Mandarin DMS Chinese Mandarin 07/2023 PDF No
F-16039G Waiver of Administrative Disqualification Hearing, German DMS German 05/2018 PDF No
F-16039H Waiver of Administrative Disqualification Hearing, Hmong DMS Hmong 07/2023 PDF No
F-16039KU Waiver of Administrative Disqualification Hearing, Kurdish DMS Kurdish 05/2018 PDF No
F-16039L Waiver of Administrative Disqualification Hearing, Laotian DMS Laotian 05/2018 PDF No
F-16039R Waiver of Administrative Disqualification Hearing, Russian DMS Russian 07/2023 PDF No
F-16039SO Waiver of Administrative Disqualification Hearing, Somali DMS Somali 07/2023 PDF No
F-16039S Waiver of Administrative Disqualification Hearing, Spanish DMS Spanish 07/2023 PDF No
F-62369 Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF) DQA English 04/2009 PDF No
F-62369 Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF) DQA English 04/2009 Word No
F-62369S Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF), Spanish DQA Spanish 04/2009 Word No
F-62369S Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF), Spanish DQA Spanish 04/2009 PDF No
F-60289 Waiver or Variance Request - Community Mental Health and Substance Abuse Treatment Services DQA English 09/2023 Word No
F-03039 WCESIL Membership Agreement DPH 05/2022 HTML No
F-01302 Weekly Driver's Vehicle Inspection Report DMS English 09/2019 Word No
F-01302 Weekly Driver's Vehicle Inspection Report DMS English 09/2019 PDF No
F-02007 WI HPP Exercise and Real Event Report DPH 06/2022 HTML No
F-03025 WI Tribal Health Department: Diabetes Prevention Funding Progress Report DPH 03/2023 HTML No
F-03076 WI Vaccine 3rd Party Scheduling Tracker DPH 08/2022 HTML No
F-03075 WI Vaccine Support- All Calls Tracker DPH 07/2022 HTML No
F-01821 WIC Authorized Infant Formula Supplier Application DPH English 04/2022 Word No
F-44624 WIC Budget - Current Year DPH English 06/2022 Excel No
F-44161A WIC Cardholder Rights and Responsibilities DPH English 08/2023 PDF No
F-44161AH WIC Cardholder Rights and Responsibilities, Hmong DPH Hmong 08/2023 PDF No
F-44161AS WIC Cardholder Rights and Responsibilities, Spanish DPH Spanish 08/2023 PDF No
F-00555T WIC CARS Expenditure Report Tribal Workbook DPH English 01/2022 Excel No
F-00555 WIC CARS Expenditure Report Workbook DPH English 01/2022 Excel No
F-82009II WIC Confidential Information Release Authorization DPH English 11/2017 PDF Yes
F-82009IIH WIC Confidential Information Release Authorization - Hmong DPH Hmong 11/2017 PDF No
F-82009IIS WIC Confidential Information Release Authorization - Spanish DPH Spanish 11/2017 PDF No
F-00554 WIC Electronic Expenditure Report Certification DPH English 01/2012 Word No
F-44755 WIC Farmers' Market Nutrition Program DPH 10/2000 HTML No
F-03043 WIC Medical Formula Order DPH 06/2022 HTML No
F-44160A WIC Plastic Cover for WIC ID Folder (order in multiples of 200) DPH 07/2009 Paper Yes
F-02040 WIC Program Notice of Categorical Ineligibility DPH English 08/2023 Word No
F-02040H WIC Program Notice of Categorical Ineligibility, Hmong DPH Hmong 08/2023 Word No
F-02040S WIC Program Notice of Categorical Ineligibility, Spanish DPH Spanish 08/2023 Word No
F-40085 WIC Program Notice of Ineligibility DPH English 08/2023 Word No
F-40085 WIC Program Notice of Ineligibility DPH English 08/2023 PDF No
F-40085H WIC Program Notice of Ineligibility, Hmong DPH Hmong 08/2023 PDF No
F-40085S WIC Program Notice of Ineligibility, Spanish DPH Spanish 08/2023 PDF No
F-44024A WIC Request for Medical Food: Pregnant, Breastfeeding, and Nonbreastfeeding Postpartum Women DPH English 06/2023 Word No
F-44024D WIC Request for Medical Formula/Food: Infants and Children DPH English 06/2023 Word No
Last revised July 18, 2023