IRIS Provider

Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for Waiver Service Provider Agencies or Individuals
This form must be signed and returned to the FEA before any payment can be issued.

IRIS Participant-Hired Worker Employee Set-up
This form is intended to provide demographic information on the participant and their worker.

IRIS Participant-Hired Worker Relationship Identification
This form documents any relationship that the worker has with the participant to ensure that the following tax obligations are managed correctly: Federal Insurance Contributions Act (FICA), Federal Unemployment Tax Act (FUTA), and State Unemployment Tax Exemptions (see Internal Revenue Publication 15, Circular E, Family Employees Section).

IRIS Participant Employer/Participant-Hired Worker Employee Agreement
This form provides demographic information for the worker, as well as an indication as to the services they will provide, their proposed work schedule, and the pay rate(s) thereof.

Application for Employer Identification Number
This federal application is for a new or the activation of existing federal employer identification number (FEIN). The FEA verifies that the FEIN is not already assigned and submits the application to the IRS when the participant employer needs to obtain a FEIN.

Employer/Payer Appointment of Agent
The federal Employer/Payer Appointment of Agent form is executed by both employer and FEA.

Form W-4
The Employee’s Federal Tax Withholding Certificate form determines how much tax the participant-employer will withhold from the worker’s paycheck.

Employment Eligibility Verification I-9
The Employment Eligibility Verification form (and copies of appropriate documents) are necessary to validate citizenship or other work-related authorization.

Background Information Disclosure
Completion of this form is required under Wis. Stats. § 50.065 to ensure the worker completes a criminal and caregiver background check.

Background Information Disclosure Addendum — IRIS
This form captures the worker’s previous residences for consideration in the resulting background check.

Background Check Appeal Request — IRIS
This form captures a response from a proposed worker whose employment was denied due to the results of a background check for secondary review by the Wisconsin Department of Health Services.