Wisconsin IRIS Forms

Families First Coronavirus Response Act (FFCRA) Information

The Families First Coronavirus Response Act, or FFCRA, provides paid sick time and paid Family Medical Leave Act (FMLA) time to those affected by the novel coronavirus disease, COVID-19. iLIFE recently sent out a packet with information to all employers containing information about the FFCRA. To view those materials and additional resources, click here. 

Important Notes:

• Appropriate forms must be approved by the participant or the participant's guardian.
• If the participant has a guardian or power of attorney, forms 2848 and F-00036 are required.

_________________________________________________________________________________________________________________________________________________

NEW 2020 Forms and Information

Participant and Participant-hired Worker

• 2020 IRIS Payroll Payment Schedule - New for 2020!

Vendor

• 2020 IRIS Vendor Payment Schedule - New for 2020!

Transit

• 2020 IRIS Vendor Transit Ticket Schedule - New for 2020!

Quick Reference Documents

Participant-hired Worker

• IRIS Participant-hired Worker Start-up Packet (blank) (fillable) (sample)
• Timesheet (blank) (fillable) (sample)
• Mileage Log (blank) (fillable) (sample)
• Status Change Form (blank) (fillable)
• Payment Election Form (blank) (fillable) (electronic submission)
• 2020 IRIS Payroll Payment Schedule 

Participant

• IRIS Participant Start-up Packet (blank) (fillable) (sample) 
• Participant Reimbursement Request Form (blank) (fillable) (sample) (tips)
• Participant Payment Election Form (fillable) (electronic submission)
• 2020 IRIS Transit Ticket Schedule

Vendor

• IRIS Vendor Start-up Packet (blank) (fillable) (sample) 
• Claim Form (blank) (fillable) (sample) (tips)
• Vendor Direct Deposit Authorization Form (fillable) (electronic submission)
• 2020 IRIS Vendor Payment Schedule

Participant Forms

Start-up Forms

• Form 2678: Employer/Payer Appointment of Agent
• Form SS-4: Application for Employer Identification Number
• Form 8821: Tax Information Authorization
• Participant Payment Election Form (fillable) (electronic submission)
  Note: Voided check or typed bank verification must be attached
• If the participant has a guardian or power of attorney, the following forms are required:
  • Guardianship or Power of Attorney Document
  • Form 2848: Power of Attorney and Declaration of Representative
  • Note: Form 2848 is required if the participant has a guardian or power of attorney
  • Form F-00036: Wisconsin Power of Attorney for Finances and Property
    Note: Form F-00036 is required if the participant needs to assign a power of attorney
• 2020 IRIS Participant Start-up Packet (blank) (fillable) (sample)

Transit Order Forms

• Eau Claire Transit Order Form (fillable)
• Fond du Lac Transit Order Form (fillable)
• GO Transit (Oshkosh) Transit Order Form (fillable)
• Green Bay Metro Transit Order Form (fillable)
• Kenosha Transit Order Form (fillable)
• Madison Metro Transit Order Form (fillable)
• Maritime Metro (Manitowoc) Transit Order Form (fillable)
• Milwaukee County Transit Order Forms:
  • Bus Tickets (fillable)
  • Reduced Fare Bus Tickets (fillable)
  • Monthly Bus Pass (fillable)
  • Reduced Fare Monthly Bus Pass (fillable)
  • Transit Tickets (fillable)
• Outagamie County Transit Order Form (fillable)
• Ozaukee County Shared Ride Taxi (fillable)
• Racine Transit Order Form (fillable)
• Running, Inc. Pre-Purchased Punch Card Order Forms
  • Baraboo
  • Beaver Dam
  • Chippewa Falls
  • Marshfield
  • Mauston
  • New Richmond
  • Onalaska
  • Platteville
  • Portage
  • Prairie du Chien
  • Rice Lake
  • Richland Center
  • River Falls
  • Stoughton
  • Sun Prairie
  • Tomah
  • Viroqua
  • Westby
• Shoreline Metro Transit Order Form (fillable)
• Valley Transit (Appleton) Order Form (fillable)
• Washington County Transit Order Form (fillable)
• Waukesha Metro Transit Order Form (fillable)
• Wausau Metro Ride Order Form (fillable)

Other Participant Documents

• Participant Fiscal Employer Agent (FEA) Selection Form (fillable)
• Participant Reimbursement Request Form (fillable)
  • Sample Participant Reimbursement Request Form
  • Participant Reimbursement Request Tips
• IRIS Participant Employer Handbook: How to be an Employer
• IRIS Fiscal Employer Agent (FEA) Tips
• OSHA Standard Precautions
• Standard Precautions for Bloodborne Transmission
• Confidential Information Release Authorization (F-82009)

Note: Required to provide participant information to someone other than the participant or guardian
Note: Must be approved by participant or participant's guardian

• Portal Participant Help Guide
• 2019-2020 IRIS FEA Transfer Calendar

__________________________________________________________________________________________________________________________________________________

Participant-hired Worker Forms

Start-up Forms

• IRIS Participant-hired Worker Set-up Form (F-01201) - English, Hmong, Spanish
  Note: Approved by participant or participant's guardian
• IRIS Participant-hired Worker Relationship Identification (F-01201A) - English, Hmong, Spanish
  Note: Approved by participant or participant's guardian
• Form W-4
  • Form WT-4
    Note: Form WT-4 for the State of Wisconsin withholding is required if you are claiming exempt or if you are claiming a different exemption on your Wisconsin State Taxes than on your Federal Form W-4.
• Form I-9 (Use this link if on a mobile device)
  • The direct link to this form on the USCIS website is here. You can only open the form via this link on a laptop/desktop computer, not via a mobile device. 
  • To open, please follow these instructions:
    • Click the link and download the PDF to your computer. 
    • Right click on the file name and choose "Open with System Viewer"
  • Note: Approved by participant or participant's guardian
• Background Information Disclosure (F-82064) - English, Hmong, Spanish
• Background Information Disclosure Addendum (F-01246) - English, Hmong, Spanish
• IRIS Participant Employer / Participant-hired Worker Agreement (F-1201C) - English, Hmong, Spanish
  Note: Approved by participant or participant's guardian
• Training Verification Form (F-01201B)
  Note: Approved by participant or participant's guardian
• Payment Election Form (fillable) (electronic submission)
  Note: Voided check or typed bank verification must be attached for Direct Deposit option.
• IRIS Participant-hired Worker Start-up Packet (blank) (fillable) (sample)
• Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C)

Payment Forms

• Timesheet: (blank) (fillable) (sample) (sample with Timesheet Tips Flyer)
• Timesheet: In/Out Time (blank) (fillable) (sample)
• Mileage Log: (blank) (fillable) (sample)
• Expense Report: (blank) (fillable) (sample)

Other Participant-hired Worker Documents

• Status Change Form (fillable)
  Note: To change participant-hired worker's information, cancel direct deposit or provide termination date
• Employment Verification Form
• Permanent Bar from Employment List
• Unemployment Insurance FAQ
  Note: This document explains unemployment insurance and eligibility
• Participant-hired Worker Portal Help Guide
• IRIS Participant-hired Worker Welcome Packet

__________________________________________________________________________________________________________________________________________________

Vendor Forms

Start-up Forms

• Provider Start-up and Requirements Checklist
• Provider Application (F-01312)
• Credentialing Requirements List
• Form W-9
  • Sample Form W-9
• Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C)
• 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 (fillable)
  Note: Approved by participant or participant's guardian
• Adult Family Home Information Form (fillable)
  Note: Required for AFH providers with non-taxable income
• Vendor Direct Deposit Authorization Form (fillable) (electronic submission)
  Note: Voided check or typed bank verification must be attached
• Vendor Income Verification Request (fillable)
• Vendor Status Change Form (fillable)
• Background Information Disclosure Addendum (F-01246)
• Background Information Disclosure (English)
• Background Information Disclosure (Hmong)
• Background Information Disclosure (Spanish)
• IRIS Vendor Start-up Packet (blank) (fillable) (sample)
• IRIS Vendor Set-up Tips

Payment Forms

• Claim Form (fillable) / Claim Form (blank)

  • Sample Claim Form
  • Vendor Claims Tips

_________________________________________________________________________________________________________________________________________________

IRIS Consultant Forms

• ICA One-Pager Order Form
• ICA One-Pager Order Form - Dane County

Rights and Responsibilities

• Complaints and Grievances (F-1205F)
• Grievance Form (F-01212)
• Fraud Statement - IRIS Program (F-01261)
• IRIS Participant Appeal Rights (P-00679)
• IRIS Service Definition Manual (P-00708B)
• Participant Rights and Responsibilities Notification (F-20985)

__________________________________________________________________________________________________________________________________________________

Miscellaneous

• W-2 Reprint Request Form

iLIFE Financial Management Services
6100 North Baker Road
Glendale, WI 53209