Community Care forms for Providers

Vendor Billing Summary/Claims Processing form
To download the Vendor Billing Summary/Claims Processing form, click here.

Direct Deposit Authorization form
To download the Direct Deposit Authorization form, click here.

Adult Family Home Questionnaire
To download the Adult Family Home Questionnaire, click here.

Deposit Advice form (SAMPLE)
To download a sample of the Deposit Advice form, click here.

Federal Government forms

Form W-9
Form W-9 is the IRS form used by a company to request a taxpayer identification number. As an independent contractor, consultant or other self-employed worker providing services to another business (in this case, Community Care), you are required to fill out and submit Form W-9.

Filling out a W-9 is pretty straightforward. Just provide your name and Social Security Number, or the name and Employer Identification Number of your business. By submitting a W-9, you are certifying that the tax id number you are providing is correct and accurate and that you are not subject to backup withholding.

To download Form W-9 and filing instructions, click here.

To select and download additional related IRS forms and filing instructions, click here.

Community Care Provider Directories

Community Care Provider Directories
To download and view the various directories of current Community Care Providers, refer to the appropriate links below.

Racine Provider Directory
(updated 12/31/2007)

Milwaukee Partnership Provider Directory
(updated 12/31/2007)

Milwaukee PACE Provider Directory
(updated 12/31/2007)