Customer Help - Family Planning Only Services

To see if you may be able to enroll or to apply online, go to


Application Packet F-10182 (English, Hmong, Spanish) (PDF, 189 KB)
To apply for BadgerCare Plus including Family Planning Only Services or you can apply online at  To renew your benefits, contact your local agency.

Authorization of Representative F-10126 (English, Hmong, Spanish) (PDF, 600 KB)
To appoint someone to apply for BadgerCare Plus for you.

Change Report F-10183 (English, Hmong, Spanish) (PDF, 33 KB)
To report changes to the local agency. You can also report changes online at

Fair Hearing Request
To request a hearing if you don't agree with a decision about your benefits.

Fair Hearing Voluntary Withdrawal DHA 17 (PDF, 10 KB)
If you want to withdraw your request for a hearing.

Self-Employment Income Report Form (SEIRF) F-00107 (English, Hmong, Spanish) (PDF, 90 KB)
Use this form to report self-employment income.

Statement of Identity F-10154 (English, Hmong, Russian, Spanish) (PDF, 91 KB)
To provide proof of identity for children under 18 years of age.


Family Planning Only Services P-10068 (English)

ForwardHealth Enrollment and Benefits Handbook P-00079 (English, Hmong, Spanish) (PDF, 2.6 MB)
A handbook will be mailed to each family who applies for a ForwardHealth Plan.

Guide to Applying for Wisconsin's Health and Nutrition Programs P-16091 (English, Hmong, Spanish) (PDF, 181 KB)

ACCESS/Marketplace Takeaway Card P-00555 (English, Spanish) (PDF, 549 KB)

Other Links

More information about the Family Planning Only Services program.

Agency Directory
To find the telephone number and address of your local agency.

Find a provider
If you need to find a BadgerCare Plus provider in your area.

Income Limits
To find current income limits.

Legal Services (PDF, 189 KB)
To find the name and telephone number of who in your area can provide you with legal help. You may also go to:

Last Revised: March 19, 2015