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TAP Application, F-02306 (4/2020)

Telecommunication Assistance Program (TAP) Application

NOTICE:
Complete this application to apply for TAP assistance. Application will be processed in the order received and approved if it meet the program’s income eligibility guidelines. Eligible applicants must provide documentation of hearing loss.

If you require assistance completing the application or have any questions about the program, please call the TAP office at 608-267-7195 or contact us by email at DHSTAP@dhs.wisconsin.gov or visit our website at DHS TAP.

Please Note: TAP applicants can only apply once every three years.
1. Applicant information
This question requires a valid number format.
Phone Type
This question requires a valid email address.
2. I am: (select one) *This question is required.
Enter your most recent annual adjusted gross income for your household, as reported on your Wisconsin Income Tax Return, OR total of all household income, including spouse if applicable, Social Security, wages, SSI, and other benefits. Proof of income may be requested.
This question requires a valid currency format.
This question requires a valid number format.
5. Select the assistance you are applying for:
7. I understand that I will need to include ONE of the following document options to complete my TAP application.

Select applicable documentation:
8. Upload your hearing loss certification documentation here, if available. (Max file size: 1 MB)
10. Voucher for telecommunication equipment assistance will be sent directly to the applicant, unless otherwise noted here.
I authorize the TAP voucher to be sent to:
NOTE DISCLAIMERS:
  • A person eligible for or receiving services from the Department of Workforce Development’s Division of Vocational Rehabilitation (DVR) shall first be evaluated by DVR to determine if the person is eligible for a telecommunication device under the vocational rehabilitation program, and if denied by DVR the person may apply for TAP assistance.
  • Preference will be given to individuals who are not receiving telecommunication devices from another state program.
I certify that all information provided on this application, including information about my disability and income, are true, complete, and accurate to the best of my knowledge. I authorize TAP program representatives to verify the information provided. I permit my information to be exchanged as needed with internal and external agencies, organizations, or individuals as program policies dictate for the administration of the program and for the delivery of equipment and services.
11. I agree and give consent. *This question is required.
Please note: this application will not be processed without consent.
14. Relationship, if not applicant.
15. Should we have any questions about the application, please provide your contact information below.
This question requires a valid email address.
Please use the submit button below to send your application information to the TAP Program Coordinator. You will have an opportunity to save or print this form for your records once it has been submitted.