Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Wis. Stat. § 450.076, the required renewal date for the Medical Oxygen Provider credential is 05/31/even years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
Effective May 1, 2015, all providers of home medical oxygen must be licensed by the Department (§450.076).
In order to obtain a Home Medical Oxygen Provider license, an applicant must be accredited by an approved organization (see the application below for a list of approved organizations).
Application for Licensure
3075||Application For Home Medical Oxygen Provider|
|3217||Application for Fee Reduction (This form must accompany the application for the credential)|
3085||Application for Predetermination (Optional-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)|
2252||Convictions and Pending Charges|
3071||Fax Payment Form|