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DEPARTMENT OF HEALTH SERVICES Division of Long Term Care F-01020 (06/12) STATE OF WISCONSIN DHS 107.09(4)(h), Wis. Admin. Code FORWARDHEALTH REQUEST FOR NURSING HOME CARE DETERMINATION Instructions:
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How to fill out Wisconsin Form F 01020:

01
Gather all necessary information and documents, such as personal identification, income records, and any supporting documents required for the specific purpose of the form.
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Read the instructions provided with Form F 01020 carefully to understand the requirements and steps involved in filling it out.
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Begin by providing basic information such as your name, address, and social security number, as requested on the form.
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Follow the form's guidelines to accurately report your income, deductions, and credits, if applicable, in the corresponding sections.
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Sign and date the form where required, certifying that the information provided is true and accurate to the best of your knowledge.
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Make a copy of the completed form for your records before submitting it to the appropriate agency or entity.

Who needs Wisconsin Form F 01020:

01
Wisconsin residents who are required to report their income, deductions, and credits for tax purposes.
02
Individuals who need to request specific services or benefits from government agencies that require the completion of this form.
03
Anyone who is mandated by state law or regulations to submit Form F 01020 for certain transactions, licenses, or registrations in Wisconsin.

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