FoodShare Wisconsin Forms and Publications

Applications | Brochures | Fact Sheets | Forms | Income Limit| Participant Handbooks | Videos | Translations

Applications

• ACCESS - Apply Online, English
• FoodShare Wisconsin Application Form - Includes the Registration and Important Information, HCF 16019A  — (English, Hmong, Russian, Spanish) (PDF, 164KB)
• FoodShare Wisconsin Application Form  - Includes the Registration, Important Information and Application, HCF 16019B  — (English, Hmong, Russian, Spanish) (PDF, 164KB)

Brochures

• FoodShare Makes Wisconsin Healthier, PHC 16063 — (English, Spanish) (PDF, 326KB)
• Guide to Applying for Wisconsin's Health and Nutrition Programs, PHC 16091, (English, Hmong, Spanish), (PDF, 181KB)

Fact Sheets

• ACCESS - Am  I Eligible?, PHC 16105 — (English) (PDF, 46KB)

• ACCESS - Apply For Benefits, PHC 16107 — (English) (PDF, 49KB)

• ACCESS - Check My Benefits, PHC 16106 — (English) (PDF, 47KB)

• Contact Us - Wallet Card, PHC 16108 — (English) (PDF, 28KB)

• Disaster FoodShare Benefits for Flood Victims, (PDF 36K)

• FoodShare Employment and Training, PHC 16092 — (English) (PDF 41K)

• FoodShare Makes Wisconsin Healthier, PHC 16062 — (English, Hmong, Russian, Spanish) (PDF, 135KB)

• FoodShare Six Month Report  Form, PHC 16078  — (English) (PDF, 26KB)

• FoodShare Wisconsin and the SHARE Wisconsin Program, PHC 16089 — (PDF,  66KB)

• Quality Assurance and Your Review, PHC 16000 (English, Hmong, Russian, Spanish) (PDF, 71KB)

• The Facts About FoodShare Wisconsin For Senior Citizens And People With Disabilities, (English, Spanish) PHC 16013 (PDF, 31KB)

• Transitional FoodShare,  PHC 16074 — (English) (PDF, 24KB)

• Wisconsin Legal Services Programs, PHC 10096 — (PDF,  37KB)

• Your Wisconsin QUEST Card, PHC 16088 — (PDF,  37KB)

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Forms

• Designation of Authorized  Buyer / Alternate Payee for FoodShare Benefits, HCF 16004 —  (English, Hmong, Russian, Spanish) (PDF, 42KB)

• FS Change Report Form, HCF 16006 —  (English, Hmong, Russian, Spanish) (PDF, 99KB)

• FS Income Change Report Form, HCF 16066 —  (English, Hmong, Russian, Spanish) (PDF, 23KB)

• Medicaid / FoodShare Wisconsin Authorization of Representative,  HCF 10126 — (English, Hmong, Spanish) (PDF, 41KB)

Income Limits

Current Income Limits (October 1, 2007 through September 30, 2008)

Participant Handbooks

•  FoodShare Wisconsin Enrollment and Benefits, PHC 16012 — (English, Hmong, Spanish)  (PDF, 276KB)

  • QUEST Card Mailer / Wallet Card Only, PHC 16075 — (English, Hmong, Russian, Spanish)  (PDF, 90KB)

Videos

All EBT videos can be found at dhfs.wisconsin.gov/em/av/ebt-vids.htm

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Translations

• Hmong Translations

  • Designation of Authorized  Buyer / Alternate Payee for FoodShare Benefits - Ntawv Taw Tus Tso Cai Siv / Tus Tso Cai Lav FoodShare Nyiaj Muas Noj, HCF 16004H — PDF (PDF, 55)

  • FoodShare Application Form - Includes the Registration and Important Information - Viv Xis Kas Xees Daim NTAWV THOV NYIAJ MUAS NOJ XWB, HCF 16019AH — PDF (PDF, 163KB)

  • FoodShare Application Form (Part 1 and Part 2) - Includes the Registration, Important Information and Application - Viv Xis Kas Xees Daim NTAWV THOV NYIAJ MUAS NOJ XWB, and Viv Xis Kas Xees Daim NTAWV THOV NYIAJ MUAS NOJ XWB COV MOJ KAB SIM (INFORMATION) TSEEM CEEB, HCF 16019BH  — PDF (PDF, 325KB)

  • FoodShare Makes Wisconsin Healthier, PHC 16062H - Nyiaj Muas Noj Ua Rau Viv Xis Kas Xees Muaj Kev Kaj Huv — PDF (PDF, 145KB)

  • FoodShare Wisconsin Change Report -DAIM NTAWV QHIA TXOG KEV HLOOV HAUV FOODSHARE WISCONSIN, HCF 16006H — PDF (PDF, 41KB)

  • FoodShare Wisconsin Eligibility and Benefits, PHC 16012H  — PDF  (PDF, 144KB)

  • FoodShare Wisconsin Income Change Report - DAIM NTAWV QHIA KEV HLOOV TXOG NYIAJ TAU HAUV FOODSHARE WISCONSIN, HCF 16066H — PDF (PDF, 35KB)

  • Medicaid / FoodShare Wisconsin Tus Tau Kev Tso Cai Sawv Cev,  HCF 10126H — PDF (PDF, 130KB) 

  • Quality Assurance and Your Review - Kev Qhia Yam Uas Zoo thiab Koj Qhov Kev Soj Ntsuam, PHC 16000H — PDF (PDF, 69KB)

• Russian Translations

  • Designation of Authorized  Buyer / Alternate Payee for FoodShare Benefits - НАЗНАЧЕНИЕ ПОЛНОМОЧНОГО ПОКУПАТЕЛЯ / АЛЬТЕРНАТИВНОГО ПОЛУЧАТЕЛЯ ЛЬГОТ ПРОГРАММЫ FOODSHARE, HCF 16004R — PDF (PDF, 218)

  • FoodShare Application Form - Includes the Registration and Important Information - РЕГИСТРАЦИонная форма, предназначенная ТОЛЬКО ДЛЯ ЗАЯВЛЕНИЙ на ПРОДОВОЛЬСТВЕННЫе Талоны В ШТАТЕ ВИСКОНСИН, HCF 16019AR — PDF (PDF,256KB)

  • FoodShare Application Form (Part 1 and Part 2) - Includes the Registration, Important Information and Application - РЕГИСТРАЦИонная форма, предназначенная ТОЛЬКО ДЛЯ ЗАЯВЛЕНИЙ на ПРОДОВОЛЬСТВЕННЫе Талоны В ШТАТЕ ВИСКОНСИН, ФОРМА, ПРЕДНАЗНАЧЕННАЯ ТОЛЬКО ДЛЯ ЗАЯВЛЕНИЙ НА ПРОДОВОЛЬСТВЕННЫЕ ТАЛОНЫ В ШТАТЕ ВИСКОНСИН Важная ИНФОРМАЦИЯ, and ФОРМА, ПРЕДНАЗНАЧЕННАЯ ТОЛЬКО ДЛЯ ЗАЯВЛЕНИЙ НА ПРОДОВОЛЬСТВЕННЫЕ ТАЛОНЫ В ШТАТЕ ВИСКОНСИН, HCF 16019BR  — PDF (PDF, 480KB)

  • FoodShare Makes Wisconsin Healthier, PHC 16062R - Продовольственные талоны делают Висконсин более здоровым — PDF (PDF, 218KB)

  • FoodShare Wisconsin Change Report, ФОРМА ДЛЯ СООБЩЕНИЯ ИЗМЕНЕНИЙ В ПРОГРАММУ FOODSHARE,HCF 16006R  — PDF (PDF, 151KB)

  • FoodShare Wisconsin Income Change Report - ФОРМА ДЛЯ СООБЩЕНИЯ ОБ ИЗМЕНЕНИЯХ В УРОВНЕ ДОХОДА В ПРОГРАММУ FOODSHARE WISCONSIN, HCF 16066R  — PDF (PDF, 144KB)

  • Quality Assurance and Your Review - Контроль качества и проверка качества предоставляемых Вам услуг, PHC 16000R — PDF (PDF, 142KB)

• Spanish Translations

  • Designation of Authorized  Buyer / Alternate Payee for FoodShare Benefits - Denominación De Un Comprador Autorizado/Pagador Alterno Para Los Beneficios De FoodShare, HCF 16004S — PDF (PDF, 42)

  • FoodShare Application Form - Includes the Registration and Important Information — FoodShare Wisconsin Inscripción/Información Importante, HCF 16019AS — PDF (PDF, 165KB)

  • FoodShare Application, Registration and Important Information — Solicitud Exclusiva Para Cupones De Alimentos De Wisconsin Inscripción , HCF 16019BS  — PDF (PDF, 332KB)

  • FoodShare Makes Wisconsin Healthier Fact Sheet, PHC 16062S - Los cupones de alimentos hacen que Wisconsin sea más saludable — PDF (PDF, 157KB)

  • FoodShare Makes Wisconsin Healthier Brochure, PHC 16063S -  Los cupones de alimentos hacen que Wisconsin sea más saludable   PDF (PDF, 326KB)

  • FoodShare Wisconsin Change Report, Informe De Cambios En El Programa FoodShare, HCF 16006S — PDF (PDF, 45KB)

  • FoodShare Wisconsin Enrollment and Benefits, PHC 16012S  — PDF (Translation Pending) (PDF, 326KB)

  • FoodShare Wisconsin Income Change Report, Informe De Cambios En Los Ingresos Del “Foodshare Wisconsin , HCF 16066S — PDF (PDF, 36KB)

  • Medicaid / FoodShare Wisconsin Authorization of Representative - Medicaid/FoodShare Wisconsin Autorización De Representante , HCF 10126S  — PDF (PDF, 29KB) 

  • Quality Assurance and Your Review - Aseguramiento de la calidad y su revisión, PHC 16000S — PDF (PDF, 82KB)

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  Last Revised: July 02, 2008