Wisconsin Emergency Information Form

State:
Multi-State
Control #:
US-1135BG
Format:
Word; 
Rich Text
Instant download

Description

The information provided on this form should be used in an emergency to notify specified individual(s) of a serious illness, injury, or incident. This information should remain confidential.
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FAQ

To add an emergency contact to your driver's license in Wisconsin, visit your local Department of Motor Vehicles (DMV) office or access the DMV website. You may need to fill out a form that includes the Wisconsin Emergency Information Form to ensure that your emergency contact details are recorded. It’s essential to keep this information updated, as it can be crucial in times of emergency.

Have a household income at or below 80% of the county median income in the month of or prior to the application date and experienced financial hardship or significant costs due to the COVID-19 public health emergency. Be at risk of becoming homeless or experiencing unstable housing.

What does emergency rental assistance cover? The federal ERA Program allows local programs to cover rent, utilities, and home energy costs. This includes electricity, gas, fuel oil, water and sewer, and trash removal.

Your household may qualify if at least one or more individuals in your home meet the following: Qualifies for unemployment, or has experienced a reduction in household income or an increase in major costs/financial struggles due to COVID-19. Experiencing a risk of being evicted or losing your home.

Beginning February 22, 2021, Wisconsin residents that have experienced a significant loss of income due to the COVID-19 pandemic and need help with their rent or utility payments can apply for the Wisconsin Emergency Rental Assistance (WERA) program.

Evictions in Wisconsin have increased since moratorium ended, and may get worse if rental assistance delays continue. Published: Friday, October 1, 2021, am.

Couleecap helps people in need with housing, food, transportation, and more. Through our actions we fight poverty, promote self-sufficiency, economic development, social justice, and personal responsibility. My husband had a massive stroke two years ago that left him disabled and unable to work for a long time.

About the Program WHEDA currently works with local agents to serve residents in 48 Wisconsin counties where there are no community programs available. Eligible families pay between 30-40% of their adjusted income for rent. The balance is subsidized by the U.S. Department of Housing and Urban Development (HUD).

You must apply for Emergency Assistance at your local Wisconsin Works (W-2) Agency. Please visit the Find a W-2 Agency page for contact information.

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Wisconsin Emergency Information Form