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TAP Application, F-02306 (08/2024)

Telecommunication Assistance Program (TAP) Application

Complete this application to apply for TAP assistance. Your application will be processed in the order it was received and approved if you meet the program’s income eligibility guidelines. Eligible applicants must provide documentation of hearing loss. The PII/PHI submitted is used only for the purpose of determining applicants' eligibility for TAP assistance.

If you require assistance completing the application or have any questions about the program, please call the TAP office at 608-266-2536, contact us by email at DHSTAP@dhs.wisconsin.gov or visit our website at https://www.dhs.wisconsin.gov/odhh/tap.htm.

TAP applicants can only apply once every three (3) years. TAP funding is limited and is on a first-come first-serve basis. A printable version of the application is available at https://www.dhs.wisconsin.gov/library/collection/f-02306.
Applicant information:
Select a Self-identifying Category: (Check only one) *This question is required.
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid number format.
This question requires a valid email address.
Phone Type (Select all that apply to your phone number.) *This question is required.
(Enter your most recent annual adjusted gross income, as reported on your Wisconsin Income Tax Return, or the total of all your household taxable income. Proof of income may be requested.) This question requires a valid currency format.
(Provide the number of members living in your home.) This question requires a valid number format.
(Example: I need help paying TEPP copay for App #123456 or I need help paying out-of-pocket costs for new phone/equipment.)
I understand I must have one of the following documents on file with TAP to complete this application. Select the documentation you have or will be providing. *This question is required.(The Hearing Loss Certification (HLC) form is now available online and printable at https://www.dhs.wisconsin.gov/library/collection/f-22554)
Upload your verification documentation here, if applicable (Maximum files: 5, Maximum file size: 2 MB).(Upload-able file types: .png, .gif, .jpg, .jpeg, .doc, .xls, .docx, .xlsx, .pdf, .txt)
I authorize the TAP voucher to be sent to: (TAP vouchers will be sent directly to the applicant, unless otherwise noted here)
DISCLAIMER: Preference will be given to individuals who are not receiving telecommunication devices from another state program. Contact the TAP Program Coordinator or visit the TAP website for more information.
CONSENT: I certify that all information provided on this application, including information about disability and income, are true, complete, and accurate to the best of my knowledge. I authorize TAP program representatives to verify the information provided. I permit this information to be exchanged as needed with internal and external agencies, organizations, or individuals as needed to process my application to the program for financial assistance.
I agree and give consent. *This question is required.
Note: This application will not be processed without consent.
Relationship to applicant:
Please provide your contact information (phone number or email address)  in case we have any follow-up questions.
This question requires a valid email address.
Please use the submit button below to send your application information to the TAP Program Coordinator. You will have an opportunity to save or print this form for your records once it has been submitted.
 
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