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Printable Form 80 Wisconsin: What You Should Know
Give the completed form to your physician, social worker(s) or therapist. 4. Complete the Social Security Disability Insurance (SDI) and/or Supplemental Security Income (SSI) application forms or the Wisconsin Supplemental Payment Application if you are not receiving SDI, if you are not receiving SSI, if you have a Wisconsin Social Security number, or if you qualify for a federal income security (FICA) or Supplemental Security Income (SSI) payment from the federal government for a disability that was determined by the Social Security Administration, (with no other disability benefits being payable by the federal government for the disability), because of severe or chronic medical conditions. (Form SDI and other forms require that the individual or a surviving relative or legal guardian of the individual apply at his/her own expense, and not at the expense of the Wisconsin Department of Health Services.) 5. If you are applying for SDI or SSI, you must complete the Social Security Information Page and select to enter your Wisconsin SSI Number. The SSI form will be mailed to the address listed on the form. 6. Submit the SDI/SSI application. 7. Note that the SDI application will be opened and the appropriate form used for the initial review by a clerk's officer or assessor. 8. The clerk's officer or assessor will notify any Wisconsin employer/employed assistance (EAA) recipients that the form has been accepted (and that the EAA recipient is not ineligible for this program), and such individuals must file within one year from the date of this notice. 9. After the clerk's officer or assessor issues an Employment Authorization Document (EAD) for the job for which you are applying, an employer or other party must either notify the local law enforcement agency that your application has been accepted or file a claim with the Wisconsin Attorney General (Civil Rights Division) in favor of you. 10. Once an employee has received his/her EAD, he/she will need to sign or provide a completed Wisconsin Certificate of Eligibility (COE) form and a copy of the original SDI/SSI Application to establish Wisconsin residency. 11. The COE must be filled out and returned to the clerk's officer immediately, as proof of Wisconsin residency is required for the EAD. 12. If you have more than one employee who is applying for EAD to establish Wisconsin residency, a separate COE for each employee is also required.
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