№ lp_1_26778
Instructional and acknowledgment form issued by a state health agency that outlines eligibility conditions, responsibilities, review steps, and decision pathways related to one-time expense funding requests within the IRIS Medicaid waiver program.
Year: 2019
State: Wisconsin
Program: IRIS
Subject: One-time expense requests
Document type: Participant education and acknowledgement form
Form number: F-01205C
Issuing authority: Department of Health Services, Division of Medicaid Services
Eligibility criteria: IRIS program participation requirements
Reviewing body: Department of Health Services
Required signatories: Participant, Guardian (if applicable), IRIS Consultant
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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