Notice: While unemployment insurance payments have not been impacted by the federal government shutdown at this time, November benefits for FoodShare members have been reduced due to the ongoing shutdown. For questions about using FoodShare benefits, information about benefit delays, or help finding food assistance resources, visit:
Wisconsin Department of Health Services' FoodShare webpage
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Document Number: DVR-12785
Description: This form is used for authorizing DVR services (paper version of an IRIS Purchase Order).
Comments: The print version of the form is published for reference purposes. This form is automated in the DVR case management system and the customizable sections are completed via automated entry.
Content Contact: DVR Forms
Document Attachment: DVR-12785 (Print Version - pdf/117 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
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