Employer Forms and Brochures
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Commuter Benefits Disability Benefits Employee Reimbursement Account Health Insurance Income Continuation Insurance Life Insurance Other Insurance Programs Wisconsin Retirement System Member Forms and Brochures Alphabetically Member Forms and Brochures by ET- Number Benefit Request Form (ET-7301)
Commuter Benefits Disability Benefits Employee Reimbursement Account Health Insurance Income Continuation Insurance Life Insurance Other Insurance Programs Wisconsin Retirement System
Member Forms and Brochures Alphabetically Member Forms and Brochures by ET- Number
Benefit Request Form (ET-7301)
Commuter Benefits Users Guide
Commuter Benefits Transit Enrollment Form
Commuter Benefits Parking Enrollment Form
Claim Filing Instructions for the Income Continuation Insurance (ICI) and Long-Term Disability Insurance (LTDI) Plans (ET-5106)
Disability Retirement Benefits Folder (ET-5107)
Disability Retirement Benefits Reference Guide (ET-5102)
2013 ERA Enrollment Form
2012 ERA Enrollment Form
Authorization to Disclose Non-Medical Individual Personal Information (ET-7406)
Medical Expense Account Continuation Election Form (ET-1518)
Remittance Report (ET-1516) (PDF Version) (Word Version)
Accumulated Leave Certification (ET-4306)
Authorization to Disclose Non-Medical Individual Personal Information (ET-7406) (PDF Version) (Word Version)
Benefit/Health Fair Request Form (ET-7117)
Continuation - Conversion Notice (ET-2311) (Word Version)
Employer Verification of Health Insurance Coverage (ET-4814)
Group Health Insurance Application/Change Form (ET-2301)
Health Insurance Election for Military Service Personnel - State (ET-2350) (PDF Version)
Health Insurance Transfer Report (ET-1615) (PDF Version) (Word Version)
Health Plan Contacts (ET-1728)
How to Become a Participating Employer Under the Wisconsin Public Employers' Group Health Insurance Program (ET-1139)
Sick Leave Escrow Application (ET-4305)
Employers should now order ICI forms directly from ETF. Use the Order Forms button at the top of this page.
Evidence of Insurability Instructions--Income Continuation Insurance (ICI) (ET-2308)
How to Become a Participating Employer Under the Wisconsin Public Employers' Group Income Continuation Insurance Program (ET-1140)
Income Continuation Insurance (ICI) Employer Statement (ET-5351) (PDF Version) (Word Version)
Income Continuation Insurance Application--Local Employee (ET- 2366)
Income Continuation Insurance Application--State Employee (ET- 2307)
Income Continuation Insurance - Claim Packet (Local) Income Continuation Insurance Booklet (ET-2129) Income Continuation Insurance Medical Report (ET-5350) Income Continuatiion Insurance Claim Instructions (ET-5352)
Income Continuation Insurance - Claim Packet (State) Income Continuation Insurance Booklet (ET-2106) Income Continuation Insurance Medical Report (ET-5350) Income Continuatiion Insurance Claim Instructions (ET-5352)
ICI Premium Table (2013 State)
ICI Premium Table (2012 State)
ICI Premium Rates - Local Government (2011) There will be a premium holiday in 2012 and 2013 for local ICI participants.
Income Continuation Insurance Report of Employment and Earnings (ET-5901) (PDF Version) (Word Version)
Income Continuation Monthly Premium Report - State (ET-1611)
Income Continuation Monthly Premium Report - UW Faculty (ET-1612)
Income Continuation Monthly Premium Report - Local (ET-1629)
Local Government Employees Monthly Life Insurance Premium Rate Chart (ET-1706) Effective Until July 1, 2013
Local Government Employees Monthly Life Insurance Premium Rate Chart (ET-1706) Effective July 1, 2013
State Employees Monthly Life Insurance Premium Rate Chart (ET-1705)
State and Local Employees Monthly Life Insurance Premium Rate Chart - Age 70 and Over
Beneficiary Designation (ET-2320)
Continued Insurance Worksheet (ET-4525)
Evidence of Insurability (ET-2305)
Group Life Insurance Collection Report - State (ET-1610)
Group Life Insurance Continuation Application (ET-2154)
How to Become a Participating Employer Under the Wisconsin Public Employer's Group Life Insurance Program (ET-1107)
Employer Resolution to Pay Entire Premium (ET-1301) Resolution for Inclusion Under Group Life Insurance (ET-1303)
Employer Resolution to Pay Entire Premium (ET-1301)
Resolution for Inclusion Under Group Life Insurance (ET-1303)
Life Insurance Application/Cancellation/Refusal (ET-2304)
Life Suite - Summary
Beneficiary Financial Counseling Will Preparation and Legal Services Travel Assistance Legacy Planning Service
Beneficiary Financial Counseling
Will Preparation and Legal Services
Travel Assistance
Legacy Planning Service
Notice of Death (ET-6301)
Notice of Death for Spouse or Dependent Child (ET-6303)
Request for Disability Premium Waiver (ET-5306)
Anthem DentalBlue Continuation
Dental Wisconsin Continuation
Epic Benefits+ Continuation
Vision Service Plan (VSP) Continuation
Agent Designation Form (ET-1313)
Authorization for Plan-to-Plan Transfer to Purchase Wisconsin Retirement System Service Credit (ET-1323)
Automated Clearing House (ACH) Direct Withdrawal Authorization (ET-1734)
Certification of Decedent's Assets (ET-3325)
Certification of Unobtainability of Spousal Consent (ET-4811)
Distribution Code/Address Specifications for Statement of Benefits (ET-9060)
Distribution Code/Address Option Selection for January 1, 2012 WRS Statement of Benefits (ET-9061)
Distribution Code/Employee Address Report (CDAD) (ET-9066)
Election to Participate in the Variable Trust Fund (ET-2356)
Electronic Reporter Transmittal (ET-2536)
Employee Identification Correction Change (ET-2810)
Employer Certification of Eligibility for Public Safety Officer Survivor Benefit Tax Exemption (ET-6329)
Employer Options for Providing Increased Retirement Benefits (ET-1137)
Employee Transaction Report (ET-2533)
Federal Withholding Requirements & Direct Rollover Option (ET-7289)
How to Become a Participating Employer Under the Wisconsin Retirement System (ET-1129)
Designation of Agent (ET-1313) Prior Service Cost Study Employees Eligible for WRS (ET-1321) Resolution of Inclusion Under the Wisconsin Retirement System (ET-1319)
Designation of Agent (ET-1313)
Prior Service Cost Study Employees Eligible for WRS (ET-1321)
Resolution of Inclusion Under the Wisconsin Retirement System (ET-1319)
Income Tax Withholding Election (ET-4310)
Limited Power-of-Attorney for Appeal (ET-4944)
Maximum Additional Contributions Worksheet (ET-2566)
New Employee Benefit Checklist (ET-2572)
On-Line Network for Employers Security Agreement (ET-8928)
Post Retirement Benefit Adjustments Historical Summary (ET-4702)
Rehired Annuitant Form (ET-2319)
USERRA Certification (ET-4560)
Federal USERRA Notice
USERRA Make-up Contributions Montly Tracking Report (ET-2573)
WRS Enrollment (ET-2316)
WRS Previous Service Checks (ET-1715)
