Voluntarily Declining Aid
Document Number: DWSP-2233
Description: This is a multiple program form for the following programs: Wisconsin Works (W-2), Child Care Assistance, Foodshare, Medicaid, Healthy Start, and QMB/SLMB. This form is to be completed by the participant to identify persons or programs for which they wish to decline aid. The participant can also request a change in a previous decision on declining aid and request a re-determination for specific persons or programs.
Document Attachments:
DWSP-2233 (English Print Version - pdf/23 KB)
DWSP-2233-H (Hmong Print Version - pdf/23 KB)
DWSP-2233-S (Spanish Print Version - pdf/22 KB)
***Should you require the necessary software to view the above attachment, please go to the Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.