IRIS Forms
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| Documents | Summary | Tags |
|---|---|---|
| 2023 IRIS Payroll Payment Schedule | IRIS Payroll Payment Schedule. This iLIFE document details the pay period start dates, end dates, due dates, and check dates for IRIS Participant-Hired Worker payments. | PPT |
| 2024 IRIS Payroll Payment Schedule | IRIS Payroll Payment Schedule. This iLIFE document details the pay period start dates, end dates, due dates, and check dates for IRIS Participant-Hired Worker payments. | PPT |
| IRIS Participant Start-up Packet - (blank)Â (fillable) (sample)Â | IRIS Participant Start-up Packet. This iLIFE packet includes all the forms a Participant needs to complete to have iLIFE as their FEA. | PPT |
| Participant Reimbursement Request Form - (blank) (fillable) (Spanish fillable)Â (sample) (tips) | Participant Reimbursement Request Form. This iLIFE form is used by Participants to request expense reimbursement for approved goods. | PPT |
| Participant Payment Election Form - (blank) (fillable) (Spanish fillable) (electronic submission) | Participant Payment Election Form. Participants complete this iLIFE form to set up direct deposit or an iLIFE pay card. | PPT |
| Form 2678: Employer/Payer Appointment of Agent | Employer/Payer Appointment of Agent. This form is pre-filled for iLIFE as the FEA. It allows the FEA to file returns and make deposits or payments of employment on behalf of the Participant employer. | PPT |
| Form SS-4: Application for Employer Identification Number | Application for Employer Identification Number. This form is pre-filled for iLIFE as the FEA. It is used to apply for an EIN on behalf of the Participant employer. | PPT |
| Form 8821: Tax Information Authorization | Tax Information Authorization. This form is pre-filled for iLIFE as the FEA. It authorizes information exchanges between the FEA and IRS. | PPT |
| IRIS Participant Employer Handbook: How to be an Employer | IRIS Participant Employer Handbook: How to be an Employer. This iLIFE document provides tips on finding, hiring, and terminating employees. | PPT |
| IRIS Fiscal Employer Agent (FEA) Tips | IRIS Fiscal Employer Agent (FEA) Tips. This iLIFE flyer provides information about navigating the IRIS program, including using timesheets, information about various forms, and how to sign up for the iLIFE Portal. | PPT |
| OSHA Standard Precautions For Your Caregivers | OSHA Standard Precautions for Your Caregivers. This iLIFE document provides information on finding OSHA guidelines for infection control and disease prevention. | PPT |
| Standard Precautions for Bloodborne Transmission | Standard Precautions for Bloodborne Transmission. This iLIFE document provides general information on preventing bloodborne transmission of disease. | PPT |
| Confidential Information Release Authorization Form (F-82009) | Confidential Information Release Authorization. Completion of this form authorizes the release of information as described on the form. | PPT |
| Portal Participant Help Guide | Participant Portal Help Guide. This guide for Participants details how to use iLIFE's IRIS timesheet portal (the iLIFE Portal). | PPT |
| IRIS FEA Transfer Calendar | IRIS FEA Transfer Calendar | PPT |
| IRIS Participant-Hired Worker Start-up Packet - (blank) (fillable) (sample) | IRIS Participant-Hired Worker Start-up Packet. This packet includes all the forms a Participant-Hired worker applicant may need to complete to be an approved service provider in the IRIS program with iLIFE. | PHW |
| IRIS Participant-Hired Worker Welcome Packet | Participant-Hired Worker Welcome Packet. iLIFE sends this packet to Participant-Hired Workers when they are approved to provide services in the IRIS program if iLIFE is their Participant's FEA. | PHW |
| Timesheet: In/Out Time - (blank) (fillable) (sample) | In/Out Timesheet. This iLIFE form is used to detail exact times services were provided by a Participant-Hired Worker to a Participant in the IRIS program. | PHW |
| Participant-Hired Worker Mileage Log - (blank) (fillable) (Spanish fillable) (sample) | Mileage Log. Participant-Hired Workers use this iLIFE form to detail transportation services provided to a Participant in the IRIS program. | PHW |
| Participant-Hired Worker Expense Report - (blank) (fillable) (sample) | Participant-Hired Worker Expense Report. This iLIFE form is used by Participant-Hired Workers to request expense reimbursement for approved goods. | PHW |
| Participant-Hired Worker Status Change Form - (blank) (fillable) (Spanish fillable) | Participant-Hired Worker Status Change Form. This iLIFE form is used by a Participant-Hired Worker to make changes to their account (such as changes to their name, address, phone, or email), to add a termination date, or to have their check stubs sent to themselves. | PHW |
| ADP MyWisely Pay Card Consent Form for Minors | Parental Consent Form for Wisely by ADP. | PHW |
| Participant-Hired Worker Payment Election Form - (blank) (fillable) (Spanish fillable) (electronic submission) | Participant-Hired Worker Payment Election Form. Participant-Hired workers complete this iLIFE form to set up direct deposit or an iLIFE pay card. | PHW |
| IRIS Participant-Hired Worker Set-up Form (F-01201) - English, Hmong, Spanish | IRIS Participant-Hired Worker Set-Up. Both the Participant-Hired Worker and Participant employer must sign and date this form for it to be considered complete. | PHW |
| IRIS Participant-Hired Worker Relationship Identification. Both the Participant-Hired Worker and Participant employer must sign and date this form for it to be considered complete. | PHW | |
| Employee's Tax Withholding Certificate - Form W-4 | Employee’s Withholding Certificate (for federal tax withholding). This form determines how much is withheld from an employee's paycheck for federal income tax. | PHW |
| Employee's Wisconsin Tax Withholding Exemption Certificate - Form WT-4 | Employee's Wisconsin Withholding Exemption Certificate/New Hire Reporting (for state tax withholding). This form determines how much is withheld from an employee's paycheck for Wisconsin income tax. | PHW |
| Form WT-4 IRS Notice 2014-7 Flyer | Form WT-4 IRS Notice 2014-7 Flyer. This iLIFE flyer provides information about IRS Notice 2014-7. | PHW |
| IRS Notice 2014-7 Caregiver Exemption Form | Notice 2014-7 Caregiver Exemption Statement. Participant-Hired Workers complete this iLIFE document to declare their caregiver exemption status. | PHW |
| Employment Eligibility Verification - Form I-9 | Employment Eligibility Verification. This form is used to verify the identity and employment authorization of individuals Hired in the United States. | PHW |
| Background Information Disclosure Form (F-82064) - English, Hmong, Spanish | Background Information Disclosure (BID) for Entity Employees and Contractors. This form captures information used to conduct background checks for individual service providers. | PHW |
| Background Information Disclosure Addendum (F-01246) - English, Hmong, Spanish | Background Information Disclosure Addendum – IRIS. This form captures additional information that may be used (if needed) to conduct background checks for Participant-Hired Worker applicants. | PHW |
| IRIS Participant Employer/Participant-Hired Worker Agreement. This form captures initial employment agreements made between the Participant and Participant-Hired Worker. | PHW | |
| Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C) | Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Waiver Service Provider Agencies or Individuals. This form details some agreements and acknowledgements service providers must agree to during the application process. | PHW |
| Pay Stub Request Form | Pay Stub Request Form. This form is used by Participant-Hired Workers to request a copy of their pay stub. | PHW |
| Employment Verification Request Form | Employment Verification Request Form. This iLIFE form is used by Participant-Hired Workers to request information regarding their employment history with a Participant in the IRIS program. | PHW |
| Participant-Hired Worker Portal Help Guide | Participant-Hired Worker Portal Help Guide. This guide for Participant-Hired Workers explains how to use iLIFE's IRIS timesheet portal (the iLIFE Portal). | PHW |
| Permanent Bar List | The Permanent Bar from Employment List can be found in the IRIS Policy Manual (P-00708A) on pages 64-66. | PHW |
| 2023 IRIS Vendor Claims Payment Schedule | IRIS Vendor Payment Schedule. This iLIFE document details the pay period start dates, end dates, due dates, and check dates for IRIS Vendor payments. | Vendor |
| 2024 IRIS Vendor Claims Payment Schedule | IRIS Vendor Payment Schedule. This iLIFE document details the pay period start dates, end dates, due dates, and check dates for IRIS Vendor payments. | Vendor |
| 2023 IRIS Vendor Transit Ticket Schedule | IRIS Vendor Transit Ticket Schedule. This iLIFE document details when transit ticket requests for a month are due, are mailed, and when they can be picked up. | Vendor |
| 2024 IRIS Vendor Transit Ticket Schedule | IRIS Vendor Transit Ticket Schedule. This iLIFE document details when transit ticket requests for a month are due, are mailed, and when they can be picked up. | Vendor |
| IRIS Vendor Start-up Packet - (blank) (sample)Â | IRIS Vendor Start-up Packet. This iLIFE packet includes all the forms a Vendor may need to complete to be an approved service provider in the IRIS program with iLIFE. | Vendor |
| Vendor Welcome Packet | Vendor Welcome Packet. iLIFE sends this packet to Vendors when they are approved to provide services in the IRIS program if iLIFE is the Participant's FEA. | Vendor |
| Vendor Claims Form - (blank) (fillable) (sample) (tips) (instructions) | Claim Form. Vendors use this form to list the services provided to a Participant in the IRIS program. | Vendor |
| Vendor Claims Submission Form FAQ | Frequently asked questions when filling out a Vendor Claims Submission Form | Vendor |
| Vendor Direct Deposit Authorization Form - (blank) (fillable) (electronic submission) | Vendor Direct Deposit Authorization. Vendors complete this iLIFE form to set up direct deposit. | Vendor |
| Provider Start-up and Requirements Checklist | Provider Start-up and Requirements Checklist. This iLIFE form details what forms a Vendor must complete for the application process as a Vendor in the IRIS program. | Vendor |
| Provider Application (F-01312) | IRIS Provider Application. Completion of this form is required to be an approved Vendor in the IRIS program. | Vendor |
| Credentialing Requirements List | IRIS Credentialing Requirements List. This iLIFE form lists the occupations/fields that require the Vendor to supply a copy of their license and/or certificate. | Vendor |
| Form W-9 | Form W-9. This IRS tax form is used to confirm a Vendor's information for tax-filing purposes. | Vendor |
| Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participant for Waiver Service Provider Agencies (F-00180C) | Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Waiver Service Provider Agencies or Individuals. This form details some agreements and acknowledgements service providers must acknowledge during the application process. | Vendor |
| IRIS License Requirements List | IRIS License Requirements List. This iLIFE form lists the occupations/fields that require the Vendor to supply a copy of their license and/or certificate. | Vendor |
| Provider Agreement (fillable) | Provider Agreement. This iLIFE form should be signed by both the Vendor and the Participant. | Vendor |
| Adult Family Home Information Form | Adult Family Home Information Form. This iLIFE form is required for Adult Family Home (AFH) providers. | Vendor |
| Vendor Income Verification Request | Vendor Income Verification Request. This iLIFE form is used by Vendors to request start date, end date, and wage history information. | Vendor |
| Vendor Status Change Form | Vendor Status Change Form. This iLIFE form is used by a Vendor to make changes to their account, such as changes to address, phone, email, business name, and end date. | Vendor |
| Background Information Disclosure Addendum (F-01246) | Background Information Disclosure Addendum – IRIS.This form captures the worker’s previous residences for consideration in the resulting background check. | Vendor |
| Background Information Disclosure (English) | Background Information Disclosure (BID) for Entity Employees and Contractors. This form captures information used to conduct background checks for Individual Service Providers (ISP's). | Vendor |
| Background Information Disclosure (Hmong) | Background Information Disclosure (BID) for Entity Employees and Contractors. This form captures information used to conduct background checks for Individual Service Providers (ISP's). | Vendor |
| Background Information Disclosure (Spanish) | Background Information Disclosure (BID) for Entity Employees and Contractors. This form captures information used to conduct background checks for Individual Service Providers (ISP's). | Vendor |
| Grievance Form (F-01212) | Grievance - IRIS Program Form. This form is used by IRIS Participants and/or their representatives to file formal grievances regarding any aspect of the care or service provided by the program and/or its staff members. | Other |
| Fraud Statement - IRIS Program (F-01261) | Fraud Statement - IRIS Program form. This form is used to report fraud in the IRIS program. | Other |
| IRIS Participant Appeal Rights (P-00679) | IRIS Participant Appeal Rights. This document details how a Participant can request a State Fair Hearing to appeal a Notice of Action. | Other |
| IRIS Service Definition Manual (P-00708B) | IRIS Service Definition Manual. This document details the long-term care services and supports covered by the IRIS program and the qualifications providers must meet to provide such services and/or supports. | Other |
| Participant Rights and Responsibilities Notification (F-20985) | Participant Rights and Responsibilities Notification. This document details those rights granted to an Applicant/Participant of the CLTS Waiver Program. | Other |
| W-2 Reprint Request Form | Online form used to request reprints of the W-2 form. | Other |
| Grievance Form (F-01212) | Grievance - IRIS Program form. This form is used by IRIS Participants and/or their representatives to file formal grievances regarding any aspect of the care or service provided by the program and/or its staff members. | Other |
| Bay Area Rural Transit (BART) Order Form | Bay Area Rural Transit Order Form. IRIS Participants use this form to order transit service in the Ashland, Park Falls, Phillips, Minocqua, Fifield, and Butternot area if their FEA is iLIFE. | Transit |
| Beaver Dam Transit Order Form | Beaver Dam Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Beaver Dam if their FEA is iLIFE. | Transit |
| Brown Cab Transit Order Form | Brown Cab Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Edgerton, Fort Atkinson, Jefferson, Lake Mills, Medford, Monroe, Ripon, Sauk Prairie, Waupaca, Waupun, and Whitewater if their FEA is iLIFE. | Transit |
| Chippewa Falls Transit Order Form | Chippewa Falls Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Chippewa Falls if their FEA is iLIFE. | Transit |
| Clintonville Transit Order Form | Clintonville Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Clintonville if their FEA is iLIFE. | Transit |
| Door2Door (Door County) Transit Order Form | Door2Door Transit Form. IRIS Participants use this form to order transit service in the Door County area if their FEA is iLIFE. | Transit |
| Eau Claire Transit Order Form | Eau Claire Transit Order Form. IRIS Participants use this form to order transit service in Eau Claire if their FEA is iLIFE. | Transit |
| Fond du Lac Transit Order Form | Fond du Lac Transit Order Form. IRIS Participants use this form to order transit service in Fond du Lac if their FEA is iLIFE. | Transit |
| Green Bay Metro Transit Order Form | Green Bay Metro Transit Order Form. IRIS Participants use this form to order transit service in Green Bay if their FEA is iLIFE. | Transit |
| Hudson Transit Order Form | Hudson Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Hudson if their FEA is iLIFE. | Transit |
| Janesville Transit Order Form | Janesville Transit Order Form. IRIS Participants use this form to order transit service in Janesville if their FEA is iLIFE. | Transit |
| Kenosha Transit Order Form | Kenosha Transit Order Form. IRIS Participants use this form to order transit service in Kenosha if their FEA is iLIFE. | Transit |
| Madison Metro Transit Order Form | Madison Metro Transit Order Form. IRIS Participants use this form to order transit service in Madison Metro area. | Transit |
| Maritime Metro (Manitowoc) Transit Order Form | Maritime Metro (Manitowoc) Transit Order Form. IRIS Participants use this form to order transit service in metro Manitowoc area if their FEA is iLIFE. | Transit |
| Marshfield Transit Order Form | Marshfield Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Marshfield if their FEA is iLIFE. | Transit |
| Mauston Transit Order Form | Mauston Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Mauston if their FEA is iLIFE. | Transit |
| Milwaukee Bus Tickets | Milwaukee Bus Tickets form. IRIS Participants use this form to order Milwaukee bus tickets if their FEA is iLIFE. | Transit |
| Milwaukee Reduced Fare Bus Tickets | Milwaukee Reduced Fare Bus Tickets form. IRIS Participants use this form to order Milwaukee reduced-fare bus tickets if their FEA is iLIFE. | Transit |
| Milwaukee Monthly Bus Pass | Milwaukee Monthly Bus Pass form. IRIS Participants use this form to order Milwaukee bus passes if their FEA is iLIFE. | Transit |
| Milwaukee Reduced Fare Monthly Bus Pass | Milwaukee Reduced Fare Monthly Bus Pass form. IRIS Participants use this form to order Milwaukee reduced-fare bus passes if their FEA is iLIFE. | Transit |
| Milwaukee Transit Tickets | Milwaukee Transit Tickets form. IRIS Participants use this form to order Milwaukee paratransit tickets if their FEA is iLIFE. | Transit |
| New Richmond Transit Order Form | New Richmond Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in New Richmond if their FEA is iLIFE. | Transit |
| Onalaska Transit Order Form | Onalaska Transit Order Form. IRIS Participants use this form to order transit service in Onalaska if their FEA is iLIFE. | Transit |
| (Oshkosh) GO Transit Transit Order Form | GO Transit (Oshkosh) Transit Order Form. IRIS Participants use this form to order transit service in Oshkosh if their FEA is iLIFE. | Transit |
| Outagamie County Transit Order Form | Outagamie County Transit Order Form. IRIS Participants use this form to order transit service in Outagamie County if their FEA is iLIFE. | Transit |
| Ozaukee County Shared Ride Taxi | Ozaukee County Transit Order Form. IRIS Participants use this form to order transit service in Ozaukee County if their FEA is iLIFE. | Transit |
| Platteville Transit Order Form | Platteville Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Platteville if their FEA is iLIFE. | Transit |
| Portage Transit Order Form | Portage Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Portage if their FEA is iLIFE. | Transit |
| Prairie du Chien Transit Order Form | Prairie du Chien Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Prairie du Chien if their FEA is iLIFE. | Transit |
| Racine Transit Order Form | Racine Transit Order Form. IRIS Participants use this form to order transit service for Racine if their FEA is iLIFE. | Transit |
| Reedsburg Transit Order Form | Reedsburg Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Reedsburg if their FEA is iLIFE. | Transit |
| Rhinelander Transit Order Form | Rhinelander Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Rhinelander if their FEA is iLIFE. | Transit |
| Richland Center Transit Order Form | Richland Center Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Richland Center if their FEA is iLIFE. | Transit |
| River Falls Transit Order Form | River Falls Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in River Falls if their FEA is iLIFE. | Transit |
| Shawano (City Cab) Transit Order Form | Shawano Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Shawano (City Cab) if their FEA is iLIFE. | Transit |
| Shoreline (Sheboygan) Metro Transit Order Form | Shoreline Metro Transit Order Form. IRIS Participants use this form to order Shoreline Metro transit service if their FEA is iLIFE. | Transit |
| Stoughton Transit Order Form | Stoughton Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Stoughton if their FEA is iLIFE. | Transit |
| Valley Transit (Appleton) Order Form | Valley Transit (Appleton) County Transit Order Form. IRIS Participants use this form to order Valley Transit service in Appleton if their FEA is iLIFE. | Transit |
| Viroqua Transit Order Form | Viroqua Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Viroqua if their FEA is iLIFE. | Transit |
| Westby Transit Order Form | Westby Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Westby if their FEA is iLIFE. | Transit |
| Washington County Transit Order Form | Washington County Transit Order Form. IRIS Participants use this form to order transit service in Washington County if their FEA is iLIFE. | Transit |
| Waukesha Metro Transit Order Form | Waukesha County Transit Order Form. IRIS Participants use this form to order transit service in Waukesha County if their FEA is iLIFE. | Transit |
| Wausau Metro Ride Order Form | Wausau Metro Transit Order Form. IRIS Participants use this form to order transit service in the Wausau Metro area if their FEA is iLIFE. | Transit |
| Wisconsin Rapids Transit Order Form | Wisconsin Rapids Transit Order Form. IRIS Participants use this form to order Running Inc. transit service in Wisconsin Rapids if their FEA is iLIFE. | Transit |