Instructions for Request for Exemption from State Mandates
- Review the General Waiver Review Criteria and sec. 66.0143 Wis. Stats.
- Use the PA-050 form for original/revised requests.
- Mail the completed form (PA-050) and the additional material required by PA-050 item 9 to:
Wisconsin Department of Revenue
Local Government Services Section 6-97
P.O. Box 8971
Madison WI 53708-8971
- For questions regarding the form, contact at:
- Email: email@example.com,
- Phone (608) 261-5360 or
- FAX (608) 264-6887.
The Wisconsin Department of Revenue (DOR), or the responsible agency, will use the following general criteria in evaluating Section 66.0143 Wis. Stats, waiver requests received from municipalities and counties. The applicable agency will request additional information from municipalities and counties, as needed, to make informed decisions regarding unique circumstances and individual situations in which informational needs cannot be fully anticipated in advance.
- Provide state statute and/or administrative rule number that creates the state mandate for which relief is requested.
- Provide a detailed description of the reason for the request.
- Describe how the waiver will enhance the efficiency and effectiveness of municipal or county operations.
- What effects, if any, will the requested waiver have on programs or services offered by other municipalities or counties?
- State the reason why this waiver is not related to health or safety.
- Provide a description of alternative actions if the waiver is not granted.
- Estimate savings expected if the waiver is granted. Include a projection of expected savings for each year of the waiver, including any capital costs required and how they are allocated. Include total expenditures in the past year for the program or service to be waived and the overall, total expenditures (tax levy and non- tax levy) for your political entity in the most recent calendar year.
- List the names of individuals, businesses, organizations, etc., that have expressed opposition to the purposed waiver. Attach written documents of opposition (if any), letters, news articles, etc.
- Attach the following documents to the request prior to mailing.
- A copy of the resolution or ordinance from your legislative body (town board, village board, city council, county board) requesting a mandate waiver. Include the recorded vote of that body.
- A formal attestation from the Governing Body that the waiver is not related to health or safety.
- A record of public hearing, if a public hearing was held , including any adverse impact on public services offered by other municipalities or counties.
Waiver Extension Criteria
- To extend a waiver, a municipality or county must submit a written request for an extension to the Department of Revenue. The request should be submitted prior to the expiration of the current waiver.
- The request for an extension does not require a new governing body resolution, completion of a new Form PA-050 or an updated savings estimate.
- The completion of a new waiver application (PA-050), with a new governing body authorization and all required documentation is required if:
- A written wavier extension requests is not received within 60 days after a waiver's expiration date,
- If the conditions in the waiver request are amended from the original request. For example, the request is amended to request a $100,000 threshold instead of $75,000, requested for in the original request.
Page last updated Februrary 22, 2011