Community-Based Residential Facilities: Forms
New online licensure and certification system for health and residential care providers
The Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA) is launching the DHS DQA Provider Portal, a new system for licensure, background checks, plan reviews, and other provider applications for assisted living facilities, adult day care centers, personal care agencies, and substance use and mental health treatment programs. Licensure/certification applications and plan review materials will not be accepted electronically or postmarked as of November 22, 2025, as we transition to the new system. We will accept applications and plan review materials starting December 15, 2025. Applications must be submitted using the DHS DQA Provider Portal. To prepare for this transition and for more information, visit our webpage.
Background check applications for all users
To prepare for the transition to the new DHS DQA Provider Portal, the Division of Quality Assurance (DQA) will not accept any new background check applications for entity operators, non-client residents, or other required individuals for new or renewing entity license/certification applications, or for rehabilitation review applicants as of November 22, 2025.
DQA will resume accepting background check applications on December 15, 2025, through the DHS DQA Provider Portal. To prepare for this transition and for more information, visit our webpage. Caregiver background checks completed by entities for employees and contractors are not affected by this transition.
This page includes forms related to community-based residential facilities (CBRFs) in Wisconsin. Select a link to learn more.
- Assisted Living Facility Request for Waiver, Approval, Variance, or Exception, F-62548
- Assisted Living Facility Self-Report, F-02208
- CBRF Fire Inspection, F-60795
- CBRF Resident Rights Complaint Report, F-62430
- CBRF Resident Satisfaction Evaluation, F-62372
- Client Rights Office - Find forms and other information.
- Construction/Remodeling Plan Review for Health Care Facilities - Find requirements and forms.
- Health Care Facility Fire Report, F-62500
- Resident Evacuation Assessment, F-62373
- Self Supervision Evaluation and Waiver Request, F-60309
- Significant Change in Health Screening Instrument Model Form, F-62370
- Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a CBRF, F-62369