Forms and Publications

How to Use Forms and Publications

Additional information about the new Forms and Publications page is available in the Web Team's blog post, Reimagining the Forms and Publications page.

Click a category under 'Forms Navigation' to display a set of forms and publications. Upon making your selection, the forms and publications for that category will appear on the right side of the screen, in place of this text.

Forms and Publications screenshot

To search, begin typing a form name or number in the search field on the left side, beneath the 'Forms Navigation' heading. As you type, search results will appear on the right side of the screen, in place of this text.

Forms and Publications screenshot

The Service Center Web Team recommends using Adobe Reader, a free program, to access the PDF forms listed on this page.

Administrators

Some benefit plans have employer-only forms in addition to employee forms. To access these, click the 'View Employer Forms' link that appears (if applicable) to the right of the category heading.

Forms and Publications screenshot

Employee Reimbursement Accounts

Admin Forms

ET-1518
Continuation More Information

Medical Expense Account after termination
If you terminate employment or cease to be an eligible employee prior to the end of the plan year and do not arrange to continue your coverage, your coverage ends at the end of the month in which your last ERA payroll deduction was taken. Expenses for services provided to you after this date are not reimbursable.

Dependent Care Account after termination
If you terminate employment or cease to be an eligible employee prior to the end of the plan year, you cannot continue dependent care contributions. You can continue to request reimbursement for eligible expenses from your Dependent Care Account until you exhaust your account balance or March 15, whichever comes first, even if you have not contributed the full annual amount for which you enrolled. Valid expenses are those that are incurred for the care of a qualified dependent so that you (and your spouse) can work, look for work, or attend school full-time.

State Group Life Insurance

Forms

ET-2304
Application/ Cancellation/ Refusal More Information
Submit to your Payroll & Benefits office.
ET-2305
Evidence of Insurability More Information
  • Submit to Minnesota Life Insurance
  • If you do not enroll during your initial enrollment period, you may apply for coverage using this form.

Individual and Family Life Insurance

Forms

UWS 1301
Application/ Cancellation/ Change More Information
Submit to your Payroll & Benefits office.
03-30538
Evidence of Insurability More Information
  • Submit to Minnesota Life Insurance
  • If you do not enroll for coverage when you are first eligible or would like to increase your coverage beyond the annual increase option amount, you can apply by completing an Evidence of Insurability application.
UWS 1305
Beneficiary Designation More Information
Submit to UW System Administration.
03-30573
Conversion More Information
Submit to Minnesota Life Insurance.

University Insurance Association

UW Employees, Inc.

Forms

03-30566
Enrollment/Cancellation Application More Information
  • Submit to your Payroll & Benefits office
  • Coverage is effective on the first of the month after your Payroll & Benefits Office has received your application.
EdF75251
Evidence of Insurability More Information
Submit to Minnesota Life Insurance.
EdF 68525
Conversion More Information
Submit to Minnesota Life Insurance.
F43649B-103
Beneficiary Designation More Information
Submit to Minnesota Life Insurance.

Income Continuation Insurance

Forms

ET-2307
Application More Information
Submit to your Payroll & Benefits office.
ET-2308
Evidence of Insurability More Information
  • Submit to ETF
  • If you do not enroll for ICI coverage when you are first eligible, you can enroll only by completing an Evidence of Insurability application.
UW1456
Sick Leave Usage Election More Information
Complete this form only if you are applying for a WRS Disability annuity, an LTDI benefit, or a § 40.65 Duty Disability benefit from the Department of Employee Trust Funds at the same time that you are applying for Income Continuation Insurance benefits.

Publications

Wisconsin Retirement System

Forms

ET-2356
Participate in Variable Fund - Election More Information
Your Variable Trust Fund participation will become effective on the January 1 after the date your election is received. If you are a new WRS participant and ETF receives your Variable Trust Fund election form within 30 days after the date your WRS-covered employment begins, your election becomes effective immediately on the date your employment began.