Wisconsin IRIS Forms

Looking for the new iLIFE PHW Paperless forms and documents?

Head on over here for more information!

Looking for information on the PHW Manual Check Changes?

Head on over here for more information!

Looking for information on iLIFE Vendor and Garnishment Paperless?

Head on over here for more information!

Looking for information on the Vendor Manual Check Changes?

Head on over here for more information!

Looking for information on iLIFE Paperless Reimbursements for Participants?

Head on over here for more information!

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 2019 Forms and Information

Participant and Participant-hired Worker

• 2019 IRIS Payroll Payment Schedule - New for 2019!

Vendor

• 2019 IRIS Vendor Payment Schedule - New for 2019!

Transit

• 2019 IRIS Vendor Transit Ticket Schedule - New for 2019!

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)

Participant

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

Vendor

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

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
• IRIS Participant Start-up Packet (blank) (fillable) (sample)

Transit Order Forms

• Door County Transit Order Form (fillable)
• 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)
  • 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
  • Edgerton
  • Fort Atkinson
  • Jefferson
  • Lake Mills
  • Marshfield
  • Mauston
  • Medford
  • Monroe
  • New Richmond
  • Onalaska
  • Platteville
  • Portage
  • Prairie du Chien
  • Rice Lake
  • Richland Center
  • Ripon
  • River Falls
  • Sauk Prairie
  • Viroqua
  • Waupaca
  • Waupun
  • Westby
  • Whitewater
• 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)
• 2018 IRIS Vendor Transit Ticket Schedule - New for 2018!

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
• 2018-2019 IRIS FEA Transfer Calendar

__________________________________________________________________________________________________________________________________________________

Participant-hired Worker Forms

Start-up Forms

• IRIS Participant-hired Worker Set-up Form (F-01201)
  Note: Approved by participant or participant's guardian
• IRIS Participant-hired Worker Relationship Identification (F-01201A)
  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 Addendum (F-01246)
• Background Information Disclosure (English)
• Background Information Disclosure (Hmong)
• Background Information Disclosure (Spanish)
• IRIS Participant Employer / Participant-hired Worker Agreement (F-1201C)
  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)
• IRIS Payroll 2018 Payment Schedule

Other Participant-hired Worker Documents

• Status Change Form (fillable)
  Note: To change participant-hired worker's information, cancel direct deposit or provide termination date
• ​Rate Change Form (fillable) (sample)
  Note: To add or change rates for a  participant-hired worker
• 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 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 2018 Vendor Payment Schedule

_________________________________________________________________________________________________________________________________________________

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