IRIS Forms
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Start-Up Forms
â—¾ IRIS Participant Start-up Packet (blank) (fillable) (sample)
â—¾ Participant Reimbursement Request Form (blank) (fillable) (sample) (tips)
(Spanish)
â—¾ Participant Payment Election Form (blank) (fillable) (Spanish) (electronic submission)
â—¾ Form 2678: Employer/Payer Appointment of Agent
â—¾ Form SS-4: Application for Employer Identification Number
â—¾ Form 8821: Tax Information Authorization
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
â—¾ Form 2848: Power of Attorney and Declaration of Representative
Note: Form 2848 is required if the Participant has a Guardian or Power of Attorney
â—¾ 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.
Transit
Running, Inc. Pre-Purchased Punch Card Order Forms
â—¾ Beaver Dam
â—¾ Brown Cab
â—¾ Chippewa Falls
â—¾ Clintonville
â—¾ Hudson
â—¾ Marshfield
â—¾ Mauston
â—¾ New Richmond
â—¾ Onalaska
â—¾ Platteville
â—¾ Portage
â—¾ Prairie du Chien
â—¾ Reedsburg
â—¾ Richland Center
â—¾ River Falls
â—¾ Shawano (City Cab)
â—¾ Stoughton
â—¾ Viroqua
â—¾ Westby
â—¾ Wisconsin Rapids
â—¾ Bay Area Rural Transit (BART) Order Form
â—¾ Eau Claire Transit Order Form
â—¾ Fond du Lac Transit Order Form
â—¾ GO Transit (Oshkosh) Transit Order Form
â—¾ Green Bay Metro Transit Order Form
â—¾ Janesville Transit Order Form
â—¾ Kenosha Transit Order Form
â—¾ Madison Metro Transit Order Form
â—¾ Maritime Metro (Manitowoc) Transit Order Form
â—¾ Milwaukee Bus Tickets
â—¾ Milwaukee Reduced Fare Bus Tickets
â—¾ Milwaukee Monthly Bus Pass
â—¾ Milwaukee Reduced Fare Monthly Bus Pass
â—¾ Milwaukee Transit Plus Tickets
â—¾ Outagamie County Transit Order Form
â—¾ Ozaukee County Shared Ride Taxi
â—¾ Racine Transit Order Form
â—¾ Shoreline Metro Transit Order Form
â—¾ Valley Transit (Appleton) Order Form
â—¾ Waukesha Metro Transit Order Form
â—¾ Wausau Metro Transit Order Form
â—¾ Washington County Transit Order Form
Other
â—¾ Participant Reimbursement Request Form (blank) (fillable) (Spanish fillable) (sample) (tips)
â—¾ IRIS Participant Employer Handbook: How to be an Employer
â—¾ IRIS Fiscal Employer Agent (FEA) Tips
â—¾ OSHA Standard Precautions
â—¾ 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
â—¾ Portal Participant Help Guide
â—¾ IRIS FEA Transfer Calendar
Start-Up Forms
â—¾ IRIS Participant-Hired Worker Start-Up Packet (blank) (fillable) (sample)
â—¾ Participant-Hired Worker Welcome Packet
â—¾ IRIS Participant-Hired Worker Relationship Identification (F-01201A) – English, Hmong, Spanish
Note: Approved by Participant or Participant’s guardian
IRIS Participant-Hired Worker Relationship Identification
â—¾ (F-01201A) – English, Hmong, Spanish
Note: Approved by Participant or Participant’s guardian
â—¾ Form W-4
â—¾ Form WT-4
â—¾ IRS Notice 2014-7 Flyer
â—¾ IRS Notice 2014-7 Caregiver Exemption Form
â—¾ 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:
1. Click the link and download the PDF to your computer.
2. Right click on the file name and choose “Open with System Viewer”
Note: Approved by Participant or Participant’s guardian.
â—¾ Background Information Disclosure (F-82064) – English, Hmong, Spanish
â—¾ Background Information Disclosure Addendum (F-01246) – English, Hmong, Spanish
â—¾ IRIS Participant Employer / Participant-Hired Worker Agreement (F-1201C) – English, Hmong, Spanish
Note: Approved by Participant or Participant’s guardian
â—¾ Payment Election Form (blank) (fillable) (Spanish) (electronic submission)
Note: Voided check or typed bank verification must be attached for Direct Deposit option
â—¾ ADP MyWisely Pay Card Consent Form for Minors
â—¾ Status Change Form (blank) (fillable) (Spanish)
â—¾ The Permanent Bar from Employment List can be found in the IRIS Policy Manual (P-00708A) on pages 84-86: IRIS Policy Manual: Work Instructions (wisconsin.gov)
â—¾ Employment Verification Form
â—¾ Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C)
Payment Forms
â—¾ 2024 IRIS Payroll Payment Schedule
â—¾ 2025 IRIS Payroll Payment Schedule
â—¾ IRIS Timesheet: In/Out Time (blank) (fillable) (sample)
â—¾ Mileage Log (blank) (fillable) (Spanish fillable) (sample)
â—¾ Expense Report: (blank) (fillable) (sample)
â—¾ 2024 IRIS Vendor Payment Schedule
â—¾ 2025 IRIS Vendor Payment Schedule
â—¾ 2024 IRIS Vendor Transit Ticket Schedule
â—¾ 2025 IRIS Vendor Transit Ticket Schedule
â—¾ IRIS Vendor Start-up Packet (blank) (sample)
â—¾ IRIS Vendor Welcome Packet
â—¾ IRIS Vendor Claims Form Tips
â—¾ Vendor Income Verification Request
â—¾ Vendor Status Change Form
â—¾ Provider Start-up and Requirements Checklist
â—¾ Form W-9
â—¾ Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C)
â—¾ Provider Agreement (fillable)
Note: Approved by Participant or Participant’s guardian
â—¾ Adult Family Home Information Form
Note: Required for AFH providers with non-taxable income
â—¾ Vendor Direct Deposit Authorization Form (blank) (fillable) (electronic submission)
Note: Voided check or typed bank verification must be attached
– 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
Online Claims Submission Form (preferred method)
â—¾ Vendor Claims Submission Form
â—¾ Vendor Claims Submission Form FAQ
Paper Claim Form
â—¾ Claim Form (blank) (fillable) (sample) (tips) (instructions)
Vendor Claims Payment Schedule
â—¾ 2025 IRIS Vendor Claims Payment Schedule