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CLTS Waiver Sole Proprietor Registration, F-02672 (06/2021)

Welcome to the Wisconsin Children’s Long-Term Support (CLTS) Waiver Provider Online Registration for Sole Proprietors.

Thank you for your interest in delivering services for the CLTS Waiver Program. 

Registering is the first step to becoming an authorized CLTS Waiver Program provider. After completing this registration process, the Wisconsin Department of Health Services (DHS) will verify your qualifications.

Once DHS has verified your qualifications and business information, your information will be added to the public CLTS Provider Directory.
  • This public directory is available to families and lists all registered providers that meet initial qualifications for the CLTS Waiver Program.
  • Your information will be shared with county waiver agencies (CWAs) that manage the next steps in the service authorization process. 
Do not register with this form if you are a financial management services (FMS) agency or provider agency (you employ staff). FMS providers must register using F-02534 and provider agencies must register using F-02617

Do not complete the registration process if you are a direct care worker employed by a provider agency or are paid by a fiscal agent.

If you have any questions about the registration process, please email us.