o     Authorization to Disclose Information to Disability Determination Bureau (F-14014)

o     Medicaid Presumptive Disability (F-10130)

This was formerly considered a DDB form until May 2012.

o     Annuity Contracts

o     Any RFAs or applications for Medicaid or FoodShare.

o     W-2 and Related Program Application (DCF-F-DWSP2471 / DCF-F-DWSP2471-H / DCF-F-DWSP2471-S)

o     W-2 and Related Programs Registration (DCF-F-DWSP14880-E / DCF-F-DWSP14880-E-S)

o     Child Care

o     Emergency Assistance Application - Part 1 (DCF-F-DWSP2010 / DCF-F-DWSP2010-H / DCF-F-DWSP2010-S)

o     Job Access Loan Application (DCF-F-DWSP2482-E / DCF-F-DWSP2482-E-H / DCF-F-DWSP2482-E-S)

o     Back - Up Application/Participant Signature (DCF-F-DWSP11154 / DCF-F-DWSP11154-H / DCF-F-DWSP11154-S)

o     Refugee application paper work and applications for other programs such as W-2 emergency payments.

o     County issued programs

o     BadgerCare Plus - Express Enrollment for Pregnant Women Application (F-10081) / Temporary Enrollment for Family Planning Only Services (F-10119) / Disaster FoodShare Application( F-16060) / FoodShare Wisconsin Registration (F-16019A) / FoodShare Wisconsin Application (F-16019B)/ Medicaid Disability Application (F-10112)/ BadgerCare Plus Supplement to FoodShare Wisconsin Application (F-10138) / Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application (F-10129)/ Senior Care Application (F-10076) / Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet (F-10101) / Wisconsin Medicaid Supplement to FoodShare Wisconsin Application (F-10140) / F-10100

o     FSET Non-cooperation form letters asking the FoodShare be reinstated.

o     Wisconsin Veterans Home at King - Medicaid Review (F-10147)

o     CAF scanning varies based on if it was generated by CARES or provided by a Client.

–      CARES Generated: Scan the signature page only. Do not scan the multiple pages of printed responses.

–      Client provided (mail-in, walk-in, etc): Scan all pages, excluding instructions. Include Combined Application forms, blue fold-outs, white mail-ins.

o     CARES generated ACCESS applications (Apply for Benefits) are automatically stored in the ECF with the APP code.

o     When searching for APPs in ECF View, search for both CAF and APP.

o     CARES generated reviews were inadvertently labeled as CHG. until the system can be changed, search for CHG for CARES generated Reviews/Renewals.

o     CARES generated SMRFs were inadvertently labeled as CHG. Until the system can be changed, search for CHG for CARES generated SMRFs.

o     Life Estate legal documents

o     Land contracts

o     Trusts

o     Tax Bill

o     Assessment

o     Retirement account information

o     Home equity loan

o     Divestment Paperwork

o     F-10196 Undue Hardship

o     Checking

o     Savings

o     Certificates of deposit (CDs)

o     Bank Inquiry

o     Child Care receipts

o     Manual Child Care Authorization Sheets

o     A case cover sheet to indicate that it is a complete case file.

Special Instructions

o     This code is intended to be used in Milwaukee County, but can be used in other locations, as appropriate.  

o     Any other Child Care related document not otherwise specified.

o     All CC related worksheets, including manual Child Care payment worksheets

o     DES-11559 Child Care Payment Worksheet for edited Licensed Child Care Providers

o     DES-11560 Child Care Payment Worksheet for Certified and Accredited Certified Child Care Providers

o     DES-11561 Child Care Payment Worksheet for Attendance Based Payments to Licensed Child Care Providers

o     DES-11562 Child Care Payment Worksheet for Enrollment Based Payments to Licensed Child Care Providers.

o     FoodShare Wisconsin Change Report (F-16006)

o     Medicaid Change Report (F-10137)

o     FoodShare Wisconsin Income Change Report (F-16066)

o     DWSP-2001 (Change Report)

o     ACCESS Report My Changes Change Reports are stored in the ECF with the CHG code.

o     COP Assessment

o     CIP/COP Approval Letters

o     Waiver Requests

o     Family Care (pilot program) documents

o     Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant (F-10142)

o     Unprocessed Family Care, Pace, or Partnership Disenrollment Request  (F-00009)

o     5% Cost Share Monthly Copay Limit Met Letter (Individual Open in CARES Case)

o     5% Cost Share Monthly Copay Limit Met Letter (Individual not found in Open CARES Case or SSI)

o     All Child Support non-expense related documents including:

–      Initial or subsequent paternity orders

–      Court orders regarding support payments

o     Referrals to child support including:

–      Good Cause Claim (DCF-F-DWSP2019 / DCF-F-DWSP2019-H / DCF-F-DWSP2019-S)

–      Good Cause Notice (DCF-F-DWSP2018 / DCF-F-DWSP2018-H / DCF-F-DWSP2018-S)

–      Notice of Assignment: Child Support, Family Support, Maintenance, and Medical Support (DCF-F-DWSP2477 / DCF-F-DWSP2477-H / DCF-F-DWSP2477-S)

o     Notice of Assignment: Child Support, Family Support, Maintenance, and Medical Support (DCF-F-DWSP2477 / DCF-F-DWSP2477-H / DCF-F-DWSP2477-S)Any legal documents regarding Child Support should use the CS code and not LEGAL.

Special Instructions

o     For specific Child Support expenses, use CSE.

o     All Child Support expense related documents, including documents related to child support payments.

o     Any child welfare related documents including:

–      BadgerCare Plus Former Foster Care Youth (FFCY) (F-10184)

–      BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication (F-10185)

o     Voluntarily Declining Aid (DCF-F-DWSP2233 / DCF-F-DWSP2233-H / DCF-F-DWSP2233-S)

o     Death Certificates

o     All manual DDB cases

o     All contents of the DDB packet (red folder)

o     Manual DDB decision letters.

Special Instructions

o     Red folders were made obsolete after the automation of DDB processing in October 2007, except for manual DDB cases in rare instances. Use DDB for all manual DDB cases.  

o     New, more specific document codes were added in October 2007 for other types of DDB documents used in the automated DDB process. See ADDD, MADA, ADDMD, DDDOC, and DDWSH for details.

o     Use for Document tracking sheets (DTS) only.

o     EBT related documentation.

o     Paychecks

o     Check stubs

o     Paystubs

o     Employer statements

o     etc

Special Instructions

o     Treat as a multi-page document if more than one per job.

o     Estate Recovery Program Disclosure Forms

o     EVF - E form

Special Instructions

o     Must be scanned at the agency. Not scanned at the DPUs.

o     EVF-H form

Special Instructions

o     Centrally scanned.  

o     If the client turned in the form at your agency, you may scan it and act on the change.

o     FoodShare Employment and Training (FSET) Program Participation Agreement (F-00136)

o     TABE

o     Vocational assessments

o     WI careers

o     Training certificates

o     Information obtained during the enrollment of an FSET individual

o     Documentation regarding ABAWD exemptions.

o     Primarily related to funeral or burial assets.

o     All other FSET program documents in which an appropriate document type does not exist.

o     Documentation that is used to verify education received and contacts made with educational institutions or services.

o     Documentation for the FSET employment confirmation.

o     Copy of enrollment appointment letters

o     Documentation obtained during the enrollment into FSET.

o     Documents or forms used for ABAWD exemption determination.

o     Documents that support the granting of good cause.

o     DHA-28 and other written requests for a fair hearing.

o     All job search log documents

o     Documentation used to verify contact with employers including

–      copies of business cards

–      employer letters

o     All job search log documents

o     Any documentation used to verify contact with employers including:

–      Copies of business cards

–      Employer letters

o     Documents or forms that do not fit into another category.

o     Information about benefits received in other states - Out of State Inquiry.

o     All documents supporting fraud claims, minus copies that can be obtained from CARES, Fraud and Front End referral forms.

o     Supporting documents for overpayments related to fraud.  

Special Instructions

o     For all other overpayments, refer to OP.  

o     For IPV related documents, refer to SANC.

o     Envelopes from mail that has been returned to the agency.

o     Release of information form authorizing the disclosure of confidential information, school enrollment, and attendance information.

o     Resume or job application worked on while in the FSET program.

o     The FSET employment plan for a participant, including:

–      Goals

–      Action steps

–      Assigned activities

o     Documents that support the issuance of supportive services.

o     Documents or forms used for verification inquiries.

o     Documentation used to verify workfare or work experience including:

–      copies of business cards

–      employer letters

–      phone logs.

o     Historical EVF - E form

Special Instructions:

o     Previously scanned under the EVFE code.

o     Any identity or citizenship document or form including:

–      birth certificate

–      baptismal certificate

–      immigration status docs

–      drivers license

–      passport

–      state ids

–      county ids

–      P-140

o     Any documents used to meet the MA/BC citizenship and identity verification requirement including:

–      Statement of Identity for Children Under 18 Years of Age (F-10154) - Assign these to the primary person

–      Statement of Citizenship and/or Identity for Special Populations (F-10161) 

Special Instructions:

o     Do not scan birth queries or birth notification letters from the state.

o     See DC for Death Certificates.

o     F-02577

o     Guardianship papers

o     Power of  attorney

o     Divorce

o     Separation

o     Marriage certificates

o     Bankruptcy papers

o     Notice of Intent to File a Lien

o     Affidavits of Lost

o     Destroyed

o     Stolen Benefits (FIS-12768).  

Special Instructions:

o     For all Child Support legal documents, refer to CS.

o     Term, group, or whole (face and cash value)

o     Life Insurance Information request

o     Life Insurance Inquiry (F-10144)

Special Instructions

o     There is no need to copy full policy that can be obtained from Insurance Agent.

o     Medicaid Disability Application (F-10112)

o     Medicaid / BadgerCare Plus Remaining Deductible Update (F-10109)

o     MA Cert Form (3070) in order of initial date of certification

o     Spousal impoverishment allocation forms

o     Authorization for Retroactive CTS

o     Emergency MA paperwork

o     Good Faith Medicaid / BadgerCare Plus Certification (F-10111)

o     Wisconsin Well Woman Medicaid Determination (F-10075)

o     Drug test results and all documents formerly coded as MDE (Physician's Evaluation):

–      Mental health or other  incapacitation docs

–      Special needs documents (child care)

–      Pregnancy verification.

–      Drug Test Results

–      Temporary Stay for Nursing Home

–      Medicaid Purchase Plan (MAPP) - Work Requirement Exemption (F-10127) 

Special Instructions

o     See DC for Death Certificates

o     Cover sheet and all verifications of medical costs

o     Other health insurance

o     Pharmacy and doctor bills.

o     Copies of checks for BadgerCare premiums and payment coupons

o     Medicaid Purchase Plan (MAPP) Member / Premium Information (F-10122)

o     Use this document code for any nonfinancial document that doesn’t have a specific code. For example:

–      Designation of a BadgerCare Plus Essential Person (F-10186)

–      Wisconsin Funeral and Cemetery Aids program application (F-10141)

o     Non-CARES generated Notices of decision including:

–      Medicaid Member Asset Allocation Notice (F-10098)

–      Community Spouse Asset Share (F-10096)

–      Medicaid Income Allocation Notice (F-10097)

–      Funeral and Cemetery Aids Program Reimbursement Notice (F-10143)

–      Notice of Denial of Benefits/Negative Change in Benefits (F-16001)

–      Notice of Approval of Benefits/Positive Change in Benefits (F-16015)

–      Medicaid Manual Notice for Cost of Care Contribution (F-10108)

o     County generated documents or forms that do not fit into another category.  

o     Does not include documents generated by the customer or State forms, or any SeniorCare form.

o     Overpayments, underpayment and benefit recovery documents used for over payment or under payment calculation

o      Wisconsin Works (W-2) Repayment Agreement (DCF-F-DES10790)

o     Overpayment Recoupment Notice

o     FoodShare Wisconsin Nonfinancial Worksheet (F-16073)

o     FoodShare Worksheet (F-16033)

o     Wisconsin Works (W2) Overpayment Recoupment Notice (DCF-F-DES10787)

o     BV worksheets

o     Associated letters

o     Sheriff's reports and manual wage  verification used to calculate  overpayments

o     Request for Write Off or Adjustment DWSD-11439

o     State Letter of 'Acknowledgment of Receipt'

Special Instructions

o     For overpayments related to fraud, see FRAUD

o     Performance Outcome Payment Documents

o     Scan all pages received, including the signature page.

o     FoodShare TCRs

o     Other Quality Control or Quality Assurance documents.

o     Wisconsin Works (W-2) and Related Programs Authorization of Participant Representation (DCF-F-DWSP2375 / DCF-F-DWSP2375-H / DCF-F-DWSP2375-S)

o     FoodShare Authorized Buyer

o     The Authorized Representative section of ACCESS' Apply For Benefits, if completed.

o     Scan the envelope and all contents.

Special Instructions:

o     When searching for returned mail in the ECF, search for both UCOR and RET document codes.

o     Retail Initiated Adjustment Notice

o     Any release of information form including:

–      Authorization for Disclosure of Confidential Information (DCF-F-DWSP10779)

–      School Enrollment and Attendance Information Release (DCF-F-DES11297)

o     Documents related to sanctions, except W-2 hourly, including:

–      FoodShare / FSET sanctions approved or denied and sanction cures

–      Drug felony

–      All IPV documents, including W-2.  

Special Instructions:

o     For W-2 hourly sanction and strike documents, refer to WSGC  

o     Spousal Allocation Statement

o     Savings Bonds

o     School related documents used for all programs, except Learnfare, including:

–      School schedules used for Child Care authorizations

–      Financial Aid Information

–      Student Financial Aid Report (F-16021)

Special Instructions:

o     For Learnfare, refer to WLCM

o     Household information request

o     SEIRF's

o     Other self employment info

o     Tax forms for the most current tax year

o     Self-Employment Income Report DWSP-2131

o     Self-Employment Income Report (F-00107)

o     Self-Employment Income Report (F-00107)Room and board documents/ forms

o     Self-Employment Income Worksheet - Corporation (F-16034)

o     Self-Employment Income Worksheet: Partnership (Schedule K-1 and Form 1065 (F-16036)

o     Self Employment Income Worksheet - Sole Proprietor Farm and Other Business (F-16037)

o     Self-Employment Income Worksheet - Subchapter S Coproration (F-16035)

o     FoodShare Six-Month Report and Instructions (F-16076)

Special Instructions:

o     CARES generated SMRFS were inadvertently labeled as CHG.  Until the system can be changed, search for CHG for CARES generated SMRFS.

o     SSI/SSDI/Referral/Advocacy Documents

o     Application for a SSN

o     Social Security Number Referral (F-16022)

Special Instructions:

o     Only scan cards where the number has not yet been validated or has a mismatch in CARES.

o     One-time 5% Cost Share Copay Limit Set Letter for SSI Medicaid members

o     Leases

o     Residence forms

o     Lease forms

o     Shelter forms

o     Proof of rent

o     Utility bills such as phone or electric

o     Tax payments

o     Mortgage

o     Property taxes

o     Section 8 papers

o     CDA papers

o     Homeless agreement

o     In /Out of Nursing Home form

o     other residency verification

o     etc

o     Documents that serve as verification for Tax Deductions.

o     All documents that serve as verification for Tax Filers and Tax Dependents.

o     Transform Milwaukee Jobs APP & Eligibility Documents

• Treatment Needs Question (F-02547) returned by member to submit TNQ.

o     TPL/Accident Report

o     F-02603

o     Letters to other agencies and notes from the customer including:

–      Notices with changes

–      EOS forms send to another state to check for open benefits

–      Call Center E-mail correspondence

–      emails from customers reporting changes

–      etc  

Special Instructions

o     For returned mail from the post office see RET.

o     For confidential documents to W-2 service providers, refer to WSPC.

o     Prior to November 2011 UCOR was used for returned mail from the post office.  When searching for returned mail in the ECF, search for both the UCOR and RET doc codes.

o     Undue Hardship Waiver Request (F-10193)

o     Other undue hardship-related documentation.

o     Child Support

o     Alimony

o     Social Security

o     Verification of Veterans Benefits (F-10162)

o     Kinship Care

o     etc

o     All non-CARES generated request for verification documents including:

–      Checklists

–      Agency letters

–      Request for Verification (DCF-F-DWSP2303 / DCF-F-DWSP2303-H / DCF-F-DWSP2303-M / DCF-F-DWSP2303-S)

–      etc

o     Vehicle Information

o     Documents about alcohol and substance abuse.

o     This code includes but is not limited to:

–      assessments

–      diagnoses

–      treatment notes

o     Documents that verify attendance at a W-2 activity including:

–      Individual timesheets

–      Group sign-in sheets

–      Computer printouts

–      Education and training attendance documentation

–      Facilitated job search activity tracking.  

Special Instructions

o     For independent job search logs, refer to WJSL 

o     For other documents related to school, refer to SCHL

o     All Barrier Screening Tool (BST) documents

o     Wisconsin Works (W-2) Barrier Screening Tool Agreement (DCF-F-DWSP13578 / DCF-F-DWSP13578-S)

Special Instructions

o     Do not scan a paper copy of the tool unless the tool is not entered into the BST system.

o     Household Budget Worksheet for Wisconsin Works (W-2) (DCF-F-DWSP2443)

o     Referrals to outside agencies such as the DVR and CAP programs assessment referral forms, etc.

o     Work program referrals, supportive services referrals, etc.  

Special Instructions

o     For referrals within an agency, refer to OCNTY.

o     Documents about domestic violence.

o     Electronic Funds Transfer (DCF-F-DWSP10791)

o     The signature page of the CARES printed EP

o     Any paper EPs not contained in CARES

o     Wisconsin Works (W-2) Employability Plan (DCF-F-DES10788)

o     Any other supporting documentation used to supplement the information contained in the EP.

o     DWSW-11661-E W-2 Agency Time Limit Extension Record.

o     Fact Finding Review Appointment Notice (DCF-F-DWSP10782-E / DCF-F-DWSP10782-E-S)

o     Request for a Wisconsin Works (W-2) Fact Finding Review (DCF-F-DWSP10783-E / DCF-F-DWSP10783-E-H / DCF-F-DWSP10783-E-S)

o     Fact Finding Review Summary and Decision (DCF-F-DWSP10784-E / DCF-F-DWSP10784-E-S)

o     Fact Finding Review Voluntary Withdrawal (DCF-F-DWSP11155-E / DCF-F-DWSP11155-E-H / DCF-F-DWSP11155-E-S)

o     All job search log documents and any documentation used to verify contact with employers, including:

–      Copies of business cards

–      Employer letters

–      etc

Special Instructions

o     For all other attendance tracking, including facilitated job search activities, refer to WAT.

o     Learnfare release

o     Other school enrollment

o     Attendance information

o     Learnfare Case Management Plan (DCF-F-DES10789)

WME

o     Medical Exam & Capacity Form W2

o     All other work program documents in which an appropriate document type does not exist.

o     Information about benefits received in other states

o     Out of State Inquiry (W-2) form (DES-4021)

o     Wisconsin Works (W-2) Participation Agreement (DCF-F-DWSP10755 / DCF-F-DWSP10755-BRM / DCF-F-DWSP10755-H / DCF-F-DWSP10755-NE /  DCF-F-DWSP10755-S / DCF-F-DWSP10755-Y)

o     FoodShare Employment and Training (FSET) Program Participation Agreement (F-00136)

o     All W-2 placement related forms, including:

–      Trial Job Employer Agreement (DES-10759)

–      Wisconsin Works (W-2) Work Training Site Agreement (DCF-F-DWSP10792)

–      W-2 Case Management Services Agreement (DWSP-13269)

–      Worksite evaluations and participant's progress reports.  

Special Instructions

o     For worksite attendance or any other attendance documents, refer to WAT.

o     Documents about physical health, mental health, and disabilities and impairments except the W-2 Medical Examination and Capacity Form and disability-related assessments.

o     This code includes but is not limited to:

–      assessments

–      diagnoses

–      treatment notes

o     For all W-2 non-participation or non-cooperation related documents including:

–      Hourly non-participation

–      Non-participation strikes

–      Good cause documents.  

Special Instructions

o     For IPV-related docs, refer to SANC.

o     Documents to service providers outside of the W-2 agency that are confidential.

Special Instructions

o     For non-confidential documents to service providers, refer to UCOR.

o     Supportive Service Plan (DCF-F-DWSW12956-E)

o     All non-medical assessment documentation including:

–      Vocational assessments

–      Career/employment readiness assessments

–      Education assessments

–      AODA assessments

–      Domestic violence assessments

–      Self-declared needs assessments

–      Family profiles

–      etc

o     Documents about disability-related assessments.

o     This code includes but is not limited to:

–      vocational assessments

–       functional assessments

o     Vendor Payment Request (DCF-F-DWSP3147 / DCF-F-DWSP3147-S)

Application Notice for Children

Application Notice for Pregnant Women

Application Notice

Application Summary

Application Real-Time Eligibility PDF

Application Summary for Children

Application Summary for Pregnant Women

CARES Application Forms

CARES Case Summary

Admin Renewal

Caseload Management Letter 1

Correspondence Document

Disability Determination Documents

Disability Determination Worksheet

FSET Activity Report Form

FSET Employment Plan Unsigned Document

IMQA Documents

o     Documents that were coded for any requests for assistance or applications with the APP code.

o     All documents that were coded as CONF and are now coded as ROI

o     Formerly used for Apply For Benefits Application which are now coded as APP

o     Formerly used for medical provider documents

o     Formerly used for IPV Documents which are now coded as SANC

o     Formerly used for Report My Changes report which are now coded as CHG