Electronic Payment Request - Child Welfare Licensing

The purpose of this form is for submission of fee payments for Residential Care Centers, Group Homes, Shelter Care facilities and private Child Placing Agencies to the DCF Child Welfare Licensing Section. Fees payable via this page include initial license, license continuation, background check, and forfeitures.

Once the form below has been completed and all fees due have been entered, click the submit button to be routed to a US Bank webpage to complete the payment process.

You should receive an automated email response within 15 minutes of successful submission of your payment. If you do not receive this response, contact the DCF Child Welfare Licensing Section at dcfcwlsfee@wisconsin.gov.

Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].

Provider Name

Submitter First Name

Submitter Last Name

Submitter Email Address

Type of Fee

License

Initial/Probationary Licensing

Regular, Continuation Licensing

Group Home

Capacity (5-8)

Group Home Fee ($)

Residential Care Center for Child and Youth

Capacity (2+)

Residential Care Center for Child and Youth Fee ($)

Shelter Care

Capacity (1+)

Shelter Care Fee ($)

Child Placing Agency

${{cpfee}}

Caregiver Background Check

$10

Forfeiture

Amount

Enforcement ID

Enforcement ID
Enforcement ID

Licensing Fee Total

Total Fee Amount

Attach Files

Comments/Notes

Electronic Payment Request - Child Welfare Licensing

Type of Fee

Initial/Probationary Licensing

DCF-F-5720-E (N. 02/2024)