State Plan Waiver Request

Document Number:  DVR-13822

Description:  This form is to be completed by vendors who are requesting a waiver of the DVR State Plan.

Comments:  This form should be printed and completed by hand.

Content Contact:  Kristina Krizan

Document Attachment:  DVR-13822 (pdf/16 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

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