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Firms must submit it to verify ongoing eligibility and confirm that circumstances affecting disadvantaged status, ownership, and control have not changed since the last approved affidavit. The form collects firm and contact details, disadvantaged owner information, annual gross receipts, employee counts, business structure, and responses to multiple change-related compliance questions.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/annual-no-change-affidavit-form-disadvantaged-business-enterprises-program-wisconsin-dot/302656/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/annual-no-change-affidavit-form-disadvantaged-business-enterprises-program-wisconsin-dot/302656.png","ImageObject",442,249,{"name":88,"@type":89},"Maeve","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-28","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who must submit this Annual No-Change Affidavit Form?","Question",{"text":108,"@type":109},"All firms must submit it to verify eligibility for participation in the DBE program.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What happens if a firm fails to submit the affidavit and required documentation?",{"text":113,"@type":109},"Failure to submit the affidavit and documentation can result in the loss of the firm’s DBE certification.",{"name":115,"@type":106,"acceptedAnswer":116},"What must disadvantaged owners attest to on the affidavit signature page?",{"text":117,"@type":109},"They affirm there have been no changes affecting the firm’s ability to meet disadvantaged status, ownership, and control requirements, and that listed items have not changed.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},302656,1790185408,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},5909877438554,"https://ap-avatar.wpscdn.com/avatar/5600025385ad2bf12a7?_k=1778553567797529272","Wisconsin DOT Office of Business Opportunity & Equity Compliance  \n141 NW Barstow Street, Suite 218, P. O. Box 798, Waukesha, WI 53187-0798  \n(414) 335-0258; Fax: (608) 267-3641 Email: [DBE_Alert@dot.wi.gov](DBE_Alert@dot.wi.gov)  \nWISCONSIN DEPARTMENT of TRANSPORTATION DISADVANTAGED BUSINESS ENTERPRISES PROGRAM  \nAnnual No-Change Affidavit Form  \nThis form must be submitted by all firms to verify that they meet the eligibility criteria for participation in the DBE program.  \nPlease complete all sections.  \nFailure to submit this affidavit and documentation can result in the loss of your firm's DBE certification.  \nFirm Name:    \nMailing Address:    \nStreet Number City State Zip  \nBilling Address:    \n(If different) Street Number City State Zip  \nPhone Number: ( )   Fax Number: ( )    \nBusiness E-mail:    \nDisadvantaged Owner(s) Information (please list below and attach an Affidavit Signature Page for each owner):  \nName:   Phone \\#: ( )   Email:    \nName:   Phone \\#: ( )   Email:    \nName:   Phone \\#: ( )   Email:    \nList of annual gross receipts for the last five years:  \nYear 20   $    \nYear 20   $    \nYear 20   $    \nYear 20   $    \nYear 20   $    \nList number of employees: Full Time:   Part Time:    \nBusiness Structure (Check one):  \n\n|  | Sole Proprietorship |  | Partnership |  | Corporation |\n| --- | --- | --- | --- | --- | --- |\n\n\n|  | Limited Liability Corp |  | Other (Describe) |\n| --- | --- | --- | --- |\n\nWisconsin DOT Office of Business Opportunity & Equity Compliance  \n141 NW Barstow Street, Suite 218, P. O. Box 798, Waukesha, WI 53187-0798 Phone: (414) 335-0258; Fax: (608) 267-3641  \nEmail: [DBE_Alert@dot.wi.gov](DBE_Alert@dot.wi.gov)  \n1. Has the legal structure of your business changed since your last approved affidavit?  \n NO  YES  \nIf yes, please submit a DBE Change to Business form and all documentation supporting this change.  \n2. Has the legal management, ownership or control of this firm changed since your last approved affidavit?  \n NO  YES  \nIf yes, please explain, submit a DBE Change to Business form and provide documentation reflecting this change.  \n3. Did any of the disadvantaged owners of this firm obtain ownership interest in another firm since your last approved affidavit?  \n NO  YES  \nIf yes, please submit a DBE Change to Business form, provide the name of the firm(s) and all ownership percentages.  \n4. Did any of the disadvantaged owners of this firm obtain management duties in another firm since your last approved affidavit?  \n NO  YES  \nIf yes, please submit a DBE Change to Business form, provide the name of the firm(s) and list responsibilities.  \n5. Did any of the disadvantaged owners of this firm obtain employment (fulltime or part-time) elsewhere since your last approved affidavit?  \n NO  YES  \nIf yes, please submit a DBE Change to Business form, provide the name of the employer and list your responsibilities.  \n6. Considering all your assets and liabilities (excluding the value of your personal residence and the value of your disadvantaged business) is your current personal net worth greater than $1.32 million dollars, pursuant to 49 CFR Part 26, § 26.67 (a)(2){i) . (See form below for reference)  \n NO  YES  \nIf yes, please submit a copy of your current Personal Financial Statement.  \n7. Have you added any new work areas to your firm since your last approved affidavit?  \n NO  YES  \nIf yes, you may contact the DBE Office to request an expansion of your firm’s certified work areas.  \n8. Have you submitted your most recent company federal tax returns?  \n NO  YES  \nIf no, please submit your most recently filed Federal Business Tax form or submit a completed DBE Request for Tax Filing Extension form.  \nForms:  \n➢ DBE Change to Business form:  \n[https://wisconsindot.gov/Documents/formdocs/dt1012.docx](https://wisconsindot.gov/Documents/formdocs/dt1012.docx)  \n➢ Personal Financial Statement form:  \n[https://www.transportation.gov/sites/dot.gov/files/docs/DBE%20PNW%20Statement%2011-3-2014.pdf](","cbCainvCN6zqnjGz","https://ap.wps.com/l/cbCainvCN6zqnjGz","pdf",270902,"English","# Annual No-Change Affidavit Form\n## Firm information\n## Disadvantaged owner information\n## Annual gross receipts (last five years)\n## Number of employees\n## Business structure\n## No-change compliance questions\n## Affidavit signature page (for each disadvantaged owner)","[{\"question\":\"Who must submit this Annual No-Change Affidavit Form?\",\"answer\":\"All firms must submit it to verify eligibility for participation in the DBE program.\"},{\"question\":\"What happens if a firm fails to submit the affidavit and required documentation?\",\"answer\":\"Failure to submit the affidavit and documentation can result in the loss of the firm’s DBE certification.\"},{\"question\":\"What must disadvantaged owners attest to on the affidavit signature page?\",\"answer\":\"They affirm there have been no changes affecting the firm’s ability to meet disadvantaged status, ownership, and control requirements, and that listed items have not changed.\"}]","Annual No-Change Affidavit Form - Disadvantaged Business Enterprises Program - Wisconsin DOT | PDF",1789794990]