Tuberculosis (TB) Control Incentive Program - Enrollment
Enroll in the American Lung Association of Wisconsin's Tuberculosis Control Incentive Program by filling out the Tuberculosis Control Incentive Program Enrollment Form. Once you enroll, you do not need to re-enroll, but please inform us of any contact information changes.
Send or fax the enrollment form to:
American Lung Association of Wisconsin
Tuberculosis Control Incentive Program Coordinator
13100 W. Lisbon Road, Suite 700
Brookfield, WI 53005
FAX: (262) 781-5180
After the American Lung Association of Wisconsin receives your enrollment form, you will receive:
- Welcome letter
- Forms - Purchase log, disbursement record, reimbursement request, special assistance form (make copies of the forms and retain the originals for future use)
- Start-up check of $100 to be deposited in your agency's account for initial tuberculosis incentive/enabler purchases. The $100 start-up check is intended to ease cash flow by providing you a base to draw upon. However, you will be reimbursed for the incentive purchases. Essentially, allowing you to keep a $100 "cushion."