Wisconsin Shares child care subsidies require every parent in the household to take part in an approved activity such as work or school. In a two-parent or three-generation household, this voluntary form lets a provider document that one parent's disability or health condition leaves them unable to care for the children, unable to take part in an approved activity, or both, and for how long.
A doctor, physician assistant, nurse practitioner, psychiatrist or psychologist completes the Medical Information section and signs. The parent fills in their contact details, and local agency staff complete the agency section.
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Wisconsin Shares Parent Medical Exemption
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Wisconsin Administrative Code DCF 201.039(4)(a) accepts documentation from a doctor, physician assistant, nurse practitioner, psychiatrist or psychologist. The form has checkboxes for those qualifications plus an other option, and the provider prints their name and address, signs and dates the medical section.
No. The form is voluntary. The required information can be provided on medical facility letterhead or in an email sent directly from the provider to the local agency, as long as it shows whether the parent can care for the children or take part in an approved activity and how long the condition lasts.
The form defines an approved activity as employment, education or other activities that lead to work. All parents must take part in one to receive child care subsidies, which is why the provider marks whether the condition prevents participation, child care, or both.