Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Titlesort descending Division Other Location
F-45029i Instructions For School Food Safety Plan DPH
F-01721 Instructions-Calculating CLTS Foster Care Room and Board Expenses DMS
F-22637 Interagency Notification -Termination of Community Waiver Participation DMS
F-10142 Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant DMS
F-42010 Interjurisdictional Tuberculosis Notification DPH
F-42011 Interjurisdictional Tuberculosis Notification - Follow-up DPH
F-47463D Intermediate Operational Plan Components DPH
F-47463C Intermediate Technician Operational Plan Components DPH
F-01761 Intoxicated Driver Program Self-Evaluation DCTS
F-20891 Intoxicated Driver Program Supplemental Funding Request DCTS
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization DPH
F-02021 IRIS - Certified Public Accountant (CPA) Audit Checklist DMS
F-01415 IRIS Adult Family Home Taxable Income Information DMS
F-01210A IRIS Budget Amendment Provider Quote Comparison DMS
F-01210 IRIS Budget Amendment Request DMS
F-01209 IRIS Certification Acknowledgment DMS
F-01549 IRIS Certification Designation of Confidential and Proprietary Information DMS
F-01563 IRIS Consultant Agency (ICA) Provider Change Letter DMS
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist DMS
F-01208 IRIS Consultant Agency Quality Management Plan DMS
F-01208A IRIS Consultant Agency Quality Management Plan Tracking DMS
F-01240 IRIS Critical Incident Reconciliation DMS
F-01319B IRIS Denial of Enrollment Request DMS
F-01442 IRIS Disenrollment Letter - Death DMS
F-02046 IRIS Financial Projections Template DMS
F-02047 IRIS Financial Reporting Template DMS
F-01207A IRIS Fiscal / Employer Agent Quality Management Plan Tracking DMS
F-01207 IRIS Fiscal Employer Agent Quality Management Plan DMS
F-01319 IRIS Involuntary Disenrollment Request DMS
F-01556E IRIS Medicaid Cost Share Letter - Fiscal Employer Agent Transfer DMS
F-02488 IRIS Monthly Rate of Service (MROS) Discrepancy Resolution DMS
F-02470 IRIS Noncompliance Statement and Corrective Action Plan DMS
F-01206 IRIS One-Time Expense Request DMS
F-01206B IRIS One-Time Expense Request - Ramp DMS
F-01206A IRIS One-Time Expense Vendor Bid Comparison DMS
F-01947 IRIS Participant Education Manual: Acknowledgement DMS
F-01205B IRIS Participant Education: Budget Amendments DMS
F-01205C IRIS Participant Education: One-Time Expense Requests DMS
F-01205J IRIS Participant Education: Self-Directed Personal Care DMS
F-01201C IRIS Participant Employer / Participant-Hired Worker Agreement DMS
F-01201A IRIS Participant-Hired Worker Relationship Identification DMS
F-02832 IRIS Performance Improvement Project (PIP) Proposal DMS
F-02833 IRIS Performance Improvement Project Annual Report DMS
F-01310A IRIS Program Conflict of Interest Disclosure - Participant DMS
F-01310 IRIS Program Conflict of Interest Disclosure – Provider DMS
F-01200 IRIS Program Cost Share Repayment Agreement DMS
F-01556C IRIS Program Cost Share Repayment Plan Letter DMS
F-01442i IRIS Program Disenrollment Letter - Cancelled DMS
F-01442J IRIS Program Disenrollment Letter - Mismanagement DMS
F-01442K IRIS Program Disenrollment Letter - Policy Noncompliance DMS

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Last Revised: March 23, 2021