Wisconsin's Self-Directed Supports Program
Handbooks and Forms
Handbooks | Participant | Employee | Vendor | Substitute Care Facilities |
Transit Ticket Forms | Miscellaneous | Rights and Responsibilities
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Transit Ticket Forms | Miscellaneous | Rights and Responsibilities
Handbooks
Participant
Startup Forms
- Participant Checklist
- Form 2678
- Form SS-4
- Fiscal Agent Information
- IRIS Employee Wage Adjustment Guideline
- Notice: Startup Documents
- Worker's Compensation (optional)
If the participant has a guardian or power of attorney, the following forms are required:
- Guardianship or Power of Attorney Documents
- Form 56
- Instructions for Completing Form 56
Note: Form 56 is required if the participant has a guardian.
- Instructions for Completing Form 56
- Form 2848
- Instructions for Completing Form 2848
Note: Form 2848 is required if the participant has a guardian or power of attorney.
- Instructions for Completing Form 2848
- Form F-00036
Note: Form F-00036 is required if the participant needs to assign a power of attorney.
Transit Order Forms
- Eau Claire Transit Order Form
- GO Transit (Oshkosh) Transit Order Form
- Milwaukee County Transit Order Forms:
- Outagamie County Transit Order Form
- Shoreline Metro Transit Order Form
- Valley Transit Order Form
- Washington County Transit Order Form
- Waukesha Metro Transit Order Form
- Wausau Metro Ride Order Form
Other Participant Documents
- Participant Check Request Form
- Explanation Letter for Vendors
- OSHA Standard Precautions
- Standard Precautions for Bloodborne Transmission
- Confidential Information Release Authorization
Note: Required to provide participant information to someone other than the participant or guardian; approved by participant or participant's guardian.
Employee
Startup Forms
- Employee Checklist
- New Employee Set-up Form
Note: Approved by participant or participant's guardian - Form W-4
- Sample Form W-4
- Form WT-4
Note: Required only if claiming exempt on Form W-4
- Sample Form W-4
- Form I-9
Note: Approved by participant or participant's guardian- Sample Form I-9
Note: For help completing the Form I-9
- Sample Form I-9
- Copy of signed Social Security Card
- Wisconsin Medicaid Program Provider Agreement (F-00180B)
Note: Approved by participant or participant's guardian - Background Information Disclosure (English)
- Background Information Disclosure Addendum
- Direct Deposit Authorization Form
Note: With voided check or bank verification (optional) - Employer and Employee Agreement
Note: Approved by participant or participant's guardian (optional) - Training Documentation Form
Note: Approved by participant or participant's guardian (optional)
Payment Forms
- 2013 IRIS Time Report Payment Schedule
- Employee Time Report (fillable version)
Note: you can type all information in this Time Report, but you must print it for the participant or guardian and employee signatures. - Employee Time Report (blank version)
- Sample Employee Time Report
Note: Reference for help filling out the Employee Time Report.
- Sample Employee Time Report
- Employee Mileage Log (fillable version)
Note: you can type all information in this Mileage Log, but you must print it for the participant or guardian and employee signatures. - Employee Mileage Log (blank version)
- Employee Expense Report (fillable version)
Note: you can type all information in this Expense Report, but you must print it for the participant or guardian and employee signatures. - Employee Expense Report (blank version)
Other Employee Documents
- Employee Status Change Form
Note: Use the Status Change Form to change employee information. - Rate Change Form
Note: Use the Rate Change Form to add a new rate for an employee. - Employee Benefits Program
- Employee Voluntary Dental and Vision
- Permanent Bar from Employment List
Vendor
Startup Forms
- Vendor Checklist
- Vendor Application
- Accessibility Assessment Request Form
- License Requirements List
- Form W-9
- Wisconsin Medicaid Program Provider Agreement (F-00180, Traditional)
Note: Approved by participant or participant's guardian
OR - Wisconsin Medicaid Program Provider Agreement (F-00180A, Non-Traditional)
Note: Approved by participant or participant's guardian. - Copy of Liability Insurance Certificate
- Copy of Professional License and/or Certificate
Note: If applicable, see License Requirements List. - Copy of Driver's License
Note: Required if providing specialized transportation. - Provider Agreement
Note: Approved by participant or participant's guardian - Adult Family Home Information Form
Note: Required for AFH providers with non-taxable income - Vendor Direct Deposit Authorization Form
Note: With voided check or bank verification (optional).
Payment Forms
Substitute Care Facilities
Startup Forms
- Copy of Certification / Licensure
- Form W-9: Request for Taxpayer Identification Number and Certification
- Substitute Care Expense Tool - AFH
- Substitute Care Expense Tool - CBRF, RCAC, 3-4 Bed AFH (corporate)
Payment Forms
Miscellaneous
- Accessibility Assessment Guide
- Community Living Toolkit
- Employment Toolkit
- Incontinence Supplies: A Guide
- Independent Living Centers
- IRIS Financial Services Agency Tips
- IRIS Financial Services Agency Portal Help Guide: Participant / Employee
- IRIS Participant Workbook
- IRIS Plan Update Form
- Lutheran Social Services Family Home Provider Guide
- Medical and Remedial Expenses Checklist, Updated
- Remote Electronic Support Guide
- Remote Electronic Support Service Provider List
- Request for Interpretation Services
- Supportive Home Care Hour Assessment Tool
- Supportive Home Care, Personal Care, and Respite Wage Study
- Welcome to the IRIS Benefits Program
Rights and Responsibilities
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