State of Wisconsin |
Release 24-03 |
Contents
Use these instructions to help people answer questions regarding the income and benefits of people in the household. Once completed, the applicant can review the section for accuracy before going to the next section.
These pages ask for every household member's work and volunteer activities. For Katie Beckett Medicaid, work information is only asked for applicants aged 14 years and older. Volunteer information isn't collected unless the applicant is applying for FoodShare. The applicant answers the information for one household member at a time.
The Work and volunteer activities page asks who from the household works or volunteers.
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Questions | How to answer |
Does anyone in your household have work or volunteer activities? |
Select Yes or No. |
Who does work or volunteer activities?
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Select the member or members of the household that work or volunteer. |
If more than one person in the household works or volunteers, the Your household’s work and volunteer activities page displays. This page asks the applicant to select which member of the household’s income information to enter first. They return to this page after completing the work information for each person until all are done.
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Questions | How to answer |
Choose who you’d like to tell us about first. |
Select Start next to someone’s name to begin asking questions for that person. |
The next page the applicant sees depends on who is in the household and the programs they are applying for.
If the household has... | Continue to... |
Someone who works or volunteers | Step 2: Provide work and volunteer details |
No one who works or volunteers | Step 3: Determine which other household income questions will be asked |
The _____’s work and volunteer activities page asks for the type of job or volunteer work. ACCESS will show a details page to ask questions about each selection.
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Questions | How to answer |
What work or volunteer activities does _____ have? | Select all options that apply. The options vary based on the programs selected.
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There are several pages that may display based on the types of work and volunteer activities selected on the previous pages. These pages repeat for each type of work or volunteer activity until all information is entered. If the applicant has more than one of each type, enter the information about each one at a time; the page repeats as many times as necessary.
The _____’s job details page asks about the individual’s paid employment.
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Questions | How to answer |
Employer name |
Enter the name of the employer. |
Employer address (Optional) | Enter the full address of the employer. |
Employer contact number (Optional) | Enter the phone number of the employer. |
Employer FEIN (Optional) |
Enter the FEIN (Federal Employment Identification Number) of the employer. |
Job start date (Optional) |
Select the date from the calendar. |
Has this job ended recently, or will it be ending soon? |
Select Yes or No. |
Job end date
|
Select the date from the calendar. |
Date of last paycheck
|
Select the date from the calendar. |
Is this a temporary job? | This question is optional if the application includes W-2 or JAL.
Select Yes, No, or I don’t know. ("I don’t know" is only displayed if the question is optional). |
What type of position is this? Choose the answer that best applies. |
This question is optional if the application includes W-2 or JAL. |
Is this job through AmeriCorps? (Optional) | Select Yes, No, or I don’t know. |
Is _____ currently on strike? | Select Yes or No. |
Strike start date (Optional)
|
Select the date from the calendar. |
Once the applicant enters details about their job, the _____’s pay details page displays. This page asks more questions about the individual’s paid employment.
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Questions | How to answer |
How often is _____ paid by [Employer Name]? |
Select one option. |
Is _____ paid an hourly wage, or does _____ get a salary for this job? | Select Hourly wage or Salary. The answer to this question determines which question displays next. |
What is the gross amount that _____ gets each pay period?
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This question displays if the applicant selected salary on the previous question. |
What is _____’s hourly pay rate?
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This question displays if the applicant selected hourly wage to the previous question. |
How many hours per week does _____ work at this job? | Enter the number of hours per week worked. |
Does _____ get overtime, holiday, shift differential, or weekend pay? | Select Yes or No. Shift differential pay is extra pay for working outside of normal working hours. |
Does _____ get tips, bonuses, commissions or other extra income? | Select Yes or No. |
Does _____ have any pre-tax deductions for this job? (Optional) | Select Yes, No, or I don’t know. |
The next page the applicant sees depends on the other types of pay they selected on the _____’s pay details page. They may see any of these pages if they indicated they apply to them.
The _____’s other hourly pay page asks about other hourly pay indicated by the applicant.
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Questions | How to answer |
What type of other hourly pay do you get from [Employer Name]? |
Select one option. |
What’s the hourly rate for this pay? | Enter the hourly pay rate. |
How many hours per week do you work at this rate? | Enter the number of hours per week worked. |
Do you have other types of hourly pay listed above? (Optional) | Select Yes, No, or I don’t know. |
The _____’s extra pay page asks about other types of pay indicated by the applicant, including tips, bonuses, commissions or other income.
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Questions | How to answer |
What type of extra pay do you get from [Employer Name]? (optional) | Select one option. |
Average amount of extra pay per pay period. (optional) | Enter the amount of extra pay per week. |
Do you have other types of extra pay listed above? (optional) | Select Yes or No. |
The _____’s pre-tax deductions page asks about the deductions previously indicated by the applicant.
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Questions | How to answer |
What type of pre-tax deduction is this? (optional) | Select the type of deduction. |
How much is this deduction? (optional) | Enter the amount of the deduction. |
How often does this deduction occur? (optional) | Select the frequency of the deduction from the dropdown menu. |
Does _____ have more pre-tax deductions? (optional) | Select Yes or No. |
After entering all information for their job, the Additional jobs page asks the applicant has another hourly or salary wage job to report. If they have another job, they go back through the hourly or salary wage detail page.
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Questions | How to answer |
Does _____ have another paying job? (Optional) | Select Yes or No. |
Household member is self-employed (Click to show)Household member is self-employed (Click to show)
The _____’s self-employment page asks about the individual’s self-employment.
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Questions | How to answer |
What type of self-employment is this? |
Select the type of self-employment from the dropdown menu. |
Choose the business or activity that best matches what _____ does. | Select the activity from the dropdown menu. |
Business name (optional) | Enter the name of the business. |
Business ownership type (optional) | Select the ownership type from the dropdown menu. |
When did _____ start this business or activity? | Select the month from the dropdown menu and enter the year they started. |
Tax ID number or EIN (optional) | Enter the tax ID number or EIN. |
Has _____ filed taxes for this business or activity? |
Select Yes or No. If the applicant selects yes, the next question displays. |
What year did _____ last file taxes for it?
|
Enter the year that taxes were last filed. |
Has this business or activity had a significant change in income or expenses? | Select Yes, No, or I don’t know. |
On average, how much does this business or activity make each month? (optional) |
Enter the monthly amount the business or activity makes. The applicant may also select I don’t know. |
On average, what are the total expenses this business or activity has each month? (optional) |
Enter the monthly expenses the business or activity incurs. The applicant may also select I don’t know. |
On average, how many hours does _____ work at this business or activity each month? (optional) |
Enter the monthly hours worked at the business or activity. The applicant may also select I don’t know. |
Does _____ have another business or activity that makes money? (optional) |
Select Yes or No. If the applicant selects yes, the page will repeat to gather information about their other self-employment. |
Household member does in-kind work (Click to show)Household member does in-kind work (Click to show)
The _____’s in-kind work page asks about the individual’s in-kind income.
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Questions | How to answer |
Employer name |
Enter the name of the employer. |
Employer address (optional) | Enter the full address of the employer. |
Employer contact number (optional) | Enter the phone number of the employer. |
Job start date (optional) | Select the date from the calendar. |
Has this job ended recently, or will it be ending soon? | Select Yes or No. If the applicant selects yes, the next question displays. |
Job end date
|
Select the date from the calendar. |
About how many hours per month does _____ work at this job? | Enter the monthly hours worked at the business or activity. |
Does _____ have another job that pays in goods or services? (optional) |
Select Yes or No. |
The _____’s volunteer work page asks about the individual’s volunteer activities. It only displays for applications that include FoodShare.
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Questions | How to answer |
Volunteer organization name |
Enter the name of the organization. |
Volunteer organization address (optional) | Enter the full address of the organization. |
Volunteer organization contact number (optional) | Enter the phone number of the organization. |
Volunteering start date (optional) | Select the date from the calendar. |
Has _____ stopped volunteering here, or will they stop soon? | Select Yes or No. If the applicant selects yes, the next question displays. |
Volunteering end date
|
Select the date from the calendar. |
About how many hours per month does _____ volunteer here? | Enter the monthly hours worked at the business or activity. |
Does _____ volunteer at another organization? (optional) | Select Yes or No. If the applicant selects yes, the page will repeat to gather information about their other volunteer work. |
These pages ask if any household members have income from a different source than employment. The applicant answers the information for one household member at a time.
The Other income page asks if any household members receive other forms of income.
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Questions | How to answer |
Does anyone in your household have other income? |
Select Yes or No. If the applicant selects yes, the next question displays. |
Who has other income?
|
Select the member or members of the household that has other income. |
If more than one person in a household has other income the Your household’s other income page displays.
This page asks the applicant to select which member of the household’s income information to enter first. They will return to this page after completing the other income information for each person until all are done.
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Questions | How to answer |
Choose who you’d like to tell us about first. |
Select Start next to someone’s name to begin asking questions for that person. |
The next page the applicant sees depends on who is in the household and the programs they are applying for.
If the household has... | Continue to... |
Someone with other income | Step 4: Provide other income details |
No one with other income | Step 5: Other benefits |
The _____’s other income page asks for the household member’s other income types.
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Questions | How to answer |
What kind of other income does _____ have? Check all that apply. | Select all that apply. |
If the applicant selects “Other,” the Additional income sources page displays with a list of less common other income types.
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Questions | How to answer |
Child and adoption support (optional) | Select all that apply. |
Investments and assets (optional) | Select all that apply. |
Employment and retirement (optional) | Select all that apply. |
Benefits (optional) | Select all that apply. |
Military benefits (optional) | Select all that apply. |
Tribal payments (optional) | Select all that apply. |
Other payments | Select all that apply. |
There are several pages that may display based on the types of other income selected on the previous pages. These pages repeat for each person and each type of other income until everyone’s information has been provided. If the applicant has more than one of each type, enter the information about each one at a time; the page will repeat as many times as necessary.
The _____’s SSI income page asks about the individual’s Supplemental Security Income received.
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Questions | How to answer |
When did these payments start? (optional) | Select the date from the calendar. |
How often does _____ get these payments? | Select the frequency of payments from the dropdown menu. |
How much is each payment? | Enter the payment amount. |
The _____’s Social Security income page asks about the individual’s Social Security Income received.
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Questions | How to answer |
When did these payments start? (optional) | Select the date from the calendar. |
How often does _____ get these payments? | Select the frequency of payments from the dropdown menu. |
How much is each payment? | Enter the payment amount. |
The _____’s other income type page asks about the individual’s other income type received. This page repeats for each of the options selected on the Other types of income page.
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Questions | How to answer |
When did these payments start? (optional) |
This question does not display if the applicant selected Personal capital gains or losses. |
How often does _____ get these payments? |
This question does not display if the applicant selected Personal capital gains or losses. |
How much is each payment? |
This question does not display if the applicant selected Personal capital gains or losses. |
How much of each payment is taxable? |
This question displays if the applicant selected Payments from annuities or Pension or retirement support. |
Is this an expected gain or loss? |
This question displays if the applicant selected Personal capital gains or losses. |
How much does _____ expect to gain for this tax year?
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This question displays if the applicant selects gain on the previous question. Enter the expected gain for this tax year. |
How much does _____ expect to lose for this tax year?
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This question displays if the applicant selects loss on the previous question. Enter the expected loss for this tax year. |
Does _____ have additional income from [other income type]? (optional) | Select Yes or No. If the applicant selects yes, this page will repeat for the same type of other income. |
This page asks about other benefits that members of the household are receiving. This includes SNAP benefits from another state, grants or educational aid, etc.
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Questions | How to answer |
Is anyone getting grants, scholarships, or other aid for education or training? | Select Yes or No. If the applicant selects yes, the next question displays. |
Who is getting aid for education or training?
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Select the member or members getting financial aid. |
Was anyone getting SSI benefits but doesn’t anymore? | Select Yes or No. If the applicant selects yes, the next question displays. |
Who was getting SSI benefits?
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Select the member or members who was receiving SSI but is not anymore. |
Has anyone gotten an SSI approval letter, but not yet gotten a payment? | Select Yes or No. If the applicant selects yes, the next question displays. |
Who has gotten an SSI approval letter?
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Select the member or members who received an SSI approval letter but not received a payment. |
Is anyone getting Medicaid benefits from SSI 1619(b)? |
Select Yes or No. |
Who is getting Medicaid benefits through SSI 1619(b)?
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Select the member or members getting SSI 1619(b) benefits. |
The next page the applicant sees depends on the information they provided on this page and earlier pages.
If the household includes someone who... | Continue to... |
Receives grants, scholarships, or other aid for education | Step 6: Educational aid |
Is a tribal member, or child/grandchild of a tribal member and is not receiving educational aid | Step 7: Tribal benefits |
Is applying for health care and is planning to file taxes | Step 8: Household monthly income |
Is not any of the above | Step 9: Confirm information on the Summary page |
The _____’s educational aid page asks about the individual’s educational aid received.
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Questions | How to answer |
When did _____’s current school term begin? | Select the month from the dropdown menu and enter the year this term started. |
When does _____’s current school term end? | Select the month from the dropdown menu and enter the year this term started. |
What type of financial aid is _____ getting? (optional) | Select the aid type from the dropdown menu. |
Aid amount this term | Enter the aid amount received this term. |
What educational expenses does _____ have? (optional) | Select the expense type from the dropdown menu. |
Expense amount this term | Enter the expense amount for this term. |
The next page the applicant sees depends on the information they provided on this page and earlier pages.
If the household includes someone who... | Continue to... |
Is a tribal member, or child/grandchild of a tribal member and is not receiving educational aid | Step 7: Tribal benefits |
Is applying for health care and is planning to file taxes | Step 8: Household monthly income |
Is not any of the above | Step 9: Confirm information on the Summary page |
This page asks about the individual’s tribal benefits received.
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Questions | How to answer |
Is anyone in your household getting tribal income from a source that is not gaming revenue? (optional) | Select Yes or No. If the applicant selects yes, the next question displays. |
Who is getting tribal income from a source that is not gaming revenue?
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Select the member or members receiving tribal from an income that is not from gaming. |
Has anyone in your household gotten health care from Indian Health Services, a tribal program, or through a referral from one of these programs? | Select Yes or No. If the applicant selects yes, the next question displays. |
Who is getting this health care?
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Select the member or members receiving health care from Indian Health Services, a tribal program, or a referral. |
Is anyone in your household eligible to get health care from Indian Health Services, a tribal program, or through a referral from one of these programs, even if they have not needed to get this health care? | Select Yes or No. If the applicant selects yes, the next question displays. |
Who is eligible to get this health care?
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Select the member or members that are eligible. |
For certain health care applicants, this page asks about the household's annual income.
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Questions | How to answer |
What do you think _____'s total income will be in [year]? This should be the gross income, which is the amount of money you get before taxes and other deductions are taken out. (Optional) | Enter the member's expected gross annual income or select I don’t know. |
Depending on the time of year when the application is filed, the page may also ask about next year’s income, or the previous year’s income.
This question will be repeated for each applicable member of the household.
Step 9: Confirm information on the Summary page
Once completed, a summary page displays. Here, the applicant can review the sections for accuracy before going to the next section.
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This page last updated in Release Number: 24-03
Release Date: 11/15/2024
Effective Date: 11/15/2024
Notice: The content within this guide is the responsibility of the State of Wisconsin's Department of Health Services (DHS) and the Department of Workforce Development (DWD).
Publication Number: P-16101