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Feeding Assistant Program Annual Report, F-62592 (04/2022)

This is the 2021 “Feeding Assistant Program Annual Report.” This annual report is a requirement per Wisconsin Admin. Code § DHS 129.17(2). Failure to respond to this can result in revocation of the Feeding Assistant Program at your facility.

Please complete the survey by July 1, 2022. If you have any questions, contact Vickie Bergquist at 414-313-9557 or vickie.bergquist@dhs.wisconsin.gov.
1. Facility
format: 000-000-0000 or 000 000 0000