Forms

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Medicaid Disability Application, HCF 10112 (PDF, 263 KB)

Authorization to Disclose Information to Disability Determination Bureau, HCF 14014 (PDF, 168)

Medicaid / FoodShare Wisconsin Authorization of Representative, HCF 10126 (PDF, 9 KB)
Hmong (PDF, 57 KB), Russian (PDF, 104 KB), Spanish (PDF, 60 KB)

Medicaid Change Form, HCF 10137 (PDF, 75 KB)
Hmong (PDF, 14 KB), Russian (PDF, 80 KB), Spanish (PDF, 14 KB)

Medicaid Health Insurance Information, HCF 10115 (PDF, 249 KB)

Request For Fair Hearing, DHA-28 (PDF, 50 KB)