Forms and Publications

Wisconsin Supplemental Security Income, A picture of a girl with a disability at the pool

Federal Supplemental Security Income (SSI)-related publications, as well as Social Security publications, are also available.

Click the number (e.g., F-22571) of a form or publication to go to a page where you will be able to choose a language in which to view that form or publication.

Note: Some materials are available as paper versions and can be ordered by completing an online request form. Before requesting a paper version of a form or publication, review the appropriate forms or publications list to ensure it is available as a paper version. If the entry in the column "Other Location" reads "None," paper versions are not available. All other entry types will provide ordering instructions.

Forms

  • Assessment Worksheet for Natural Residential Setting, F-20817
  • Assessment Worksheet for Natural Residential Setting: For Individuals With Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses, F-20817A
  • Authorization for Recoupment Caretaker Supplement, F-22565
  • Authorization for Retroactive Caretaker Supplement, F-22564
  • Caretaker Supplement Application and Instructions, F-22571
  • Certification for SSI-E Exceptional Expense Supplement, F-20818
  • SSI-E Natural Residential Setting Application Checklist, F-20812

Handbooks

Letter Formats

The following are interim assistance reimbursement letter formats. Copy and past the text from the browser versions into a word processing file or print and use the PDF versions.

  • Authorization for Reimbursement of Interim Assistance—Initial Payment (letter format A; use this when emergency assistance is provided to people whose initial application for SSI is pending) (BROWSER or PDF, 12 KB) 
  • Authorization for Reimbursement of Interim Assistance—Initial Post-Eligibility Payment (letter format B; use this when emergency assistance is provided to individuals whose eligibility for SSI was suspended by the Social Security Administration and retroactive SSI benefits are expected) (BROWSER or PDF, 13 KB)
  • Authorization for Reimbursement of Interim Assistance—Initial Payment or Initial Post-Eligibility Payment (letter format C; this format combines the language in letter formats A and B and may be used for agencies that wish to limit the number of forms they have in use) (BROWSER or PDF,  25 KB)

Publications

  • Information About Caretaker Supplement Fact Sheet, P-23110 (PDF, 77 KB) 
  • Exceptional Expense Supplement for Members of Supplemental Security Income in Wisconsin, P-23128
  • SSI in Wisconsin 2013 Fact Sheet, P-23043 (PDF, 75 KB)
  • Supplemental Security Income and Caretaker Supplement Statistics Talking Points, P-00469 (PDF, 967 KB)
Last Revised: March 23, 2016