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Publications

Alphabetic List of Forms and Brochures

The following list contains forms for member use. You may also search forms by program or by ET- number.

Employer forms are not included in this list.

Many documents on this site are in Adobe Acrobat PDF format. Download a free version. Adobe Reader does not allow users to save completed fillable PDFs to their computer. Refer to the Adobe Web site for more information on fillable PDFs.

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A

Accumulated Sick Leave Credit Conversion Program (ASLCC) & Supplemental Health Insurance Fact Sheet (ET-8929)

Addendum-Coinsurance HMO-Standard PPO (ET-2168) Program Option 6 - 2014

Addendum-Coinsurance HMO-Standard PPO (ET-2168) Program Option 6 - 2013

Addendum-Deductible HMO-Standard PPO (ET-2158) Program Option 4 - 2014

Addendum-Deductible HMO-Standard PPO (ET-2158) Program Option 4 - 2013

Addendum-Deductible HMO-Standard Plan (ET-2158) Program Option 4 - 2012

Additional Contributions (ET-2123)

Additional Contributions Remittance (ET-2545)

Address/Name Change (ET-2815)

Administrative Appeal Process (ET-4943)

Affidavit of Termination of Domestic Partners (ET-2372)

Appeal Form (ET-4938)

Applying For Your Retirement Benefit (ET-4106)

Authorization to Disclose Medical Information (ET-7414) (Fillable Word doc)

Authorization to Disclose Non-Medical Individual Personal Information (ET-7406)

Automatic Premium Conversion Waiver/Revocation of Waiver (ET-2340)

B

Beneficiary Designation (ET-2320) (Fillable Word doc)

Beneficiary Designation (alternate form) (ET-2321) (Fillable Word doc)

Benefit Information Request (ET-7301)

Buying Creditable Service (ET-4121)

Buying Other Governmental Service (ET-2207)

C

Calculating Your Retirement Benefits (ET-4107)

Canceling Variable Participation (ET-2313)

Capital Expenditure Worksheet (ERA Program)

Change in Status Form (ERA Program)

Choosing an Annuity Option (ET-4117)

Comprehensive Annual Financal Report (ET-8501)

Conversion Information - Life Insurance (ET-2306)

Converting Your Group Life Insurance to Pay Health or Long-Term Care Insurance Premiums (ET-2325)

D

Death Benefits (ET-6101)

Deferred Compensation Program Fact Sheet (ET-8904)

Direct Deposit Authorization - Monthly (ET-7282)

Disability Retirement Benefits (ET-5107)

Domestic Partner Benefits (ET-2166)

s. 40.65 Duty Disability and Survivor Benefits (ET-5103)

E

Election to Participate in the Variable Trust Fund (ET-2356)

Employee Reimbursement Accounts Fact Sheet (ET-8900)

Employer Options for Providing Increased Retirement Benefits (ET-1137)

Employer Verification of Health Insurance Coverage (ET-4814)

ERA Benefits Booklet 2013

ERA Dependent Care Account Claim Form

ERA Health Care Account Claim Form

ERA Letter of Medical Necessity

ETF Insurance Complaint Form (ET-2405)

Evidence of Insurability (ET-2305)

Explanation of Alternate Payee Annual Statement of Benefits (ET-4927)

Explanation of Annual Statement of Benefits (ET-7333)

Evidence of Insurability (ET-2305)

F

FBMC Authorization for Release of Information

FSA/LPFSA/Transportation and Parking Remittance Report (ET-1516)

G

Group Health Insurance (ET-4112)

Group Health Insurance Application/Change Form (ET-2301)

Group Health Insurance Fact Sheet (ET-8902)

Group Life Insurance After You Terminate Employment (ET-4104)

Group Life Insurance Fact Sheet (ET-8903)

Group Life Insurance Plan Monthly Rates-2010-2011 (ET-2164)

H

How Divorce Can Affect Your WRS Benefits (ET-4925)

How Participation in the Variable Trust Affects Your WRS Benefits (ET-4930)

How Part-Time Employment Affects Your Benefits (ET-2121)

I

Income Continuation Insurance Application-State (ET-2307)

Income Continuation Insurance Application-Local (ET-2366)

Income Continuation Insurance-Local (ET-2129)
There will be a premium holiday in 2013 and 2014 for local ICI participants.

Income Continuation Insurance-Local Fact Sheet (ET-8931)

Income Continuation Insurance Plan Language-State and Local Government

Income Continuation Insurance-State (ET-2106)

Income Continuation Insurance-State Fact Sheet (ET-8918)

Income Tax Withholding Election (ET-4310)

Calculate and Print Your Income Tax Withholding Election (Retirees Only)

Information for Beneficiaries of Wisconsin Retirement System (WRS) Accounts (ET-6102)

Information for Rehired Annuitants (ET-4105)

Information for Retirees (ET-4116)

Investment Earnings Distribution Report (ET-2124)

IRS Benefits and Compensation Limits (ET-8873)

It's Your Benefit Newsletter (ET-7116)

(18ET-2156) It's Your Choice Local Annuitant Health Program (LAHP) Decision Guide 2018

(18ET-2158) It's Your Choice Local Deductible Plan Decision Guide 2018

(18ET-2168) It's Your Choice Local Health Plan Decision Guide 2018

(18ET-2169) It's Your Choice Local High Deductible Health Plan Decision Guide 2018

(18ET-2128) It's Your Choice Local Traditional Plan Decision Guide 2018

(18ET-2107) It's Your Choice State Employees and Graduate Assistants Decision Guide 2018

(18ET-2108) It's Your Choice State Retirees Decision Guide 2018

(17et2158) It's Your Choice Local Deductible Plan Decision Guide 2017

(17et2168) It's Your Choice Local Health Plan Decision Guide 2017

(17et2169) It's Your Choice Local High Deductible Health Plan Decision Guide 2017

(17et2128) It's Your Choice Local Traditional Plan Decision Guide 2017

(17et2107) It's Your Choice State Employees and Graduate Assistants Decision Guide 2017

(17et2108) It's Your Choice State Retirees Decision Guide 2017

(16et2158) It's Your Choice Local Deductible Plan Decision Guide 2016

(16et2168) It's Your Choice Local Health Plan Decision Guide 2016

(16et2169) It's Your Choice Local High Deductible Health Plan Decision Guide 2016

(16et2128) It's Your Choice Local Traditional Plan Decision Guide 2016

(16et2107) It's Your Choice State Employees and Graduate Assistants Decision Guide 2016

(16et2108) It's Your Choice State Retirees Decision Guide 2016

IYC Access Plan HDHP (ET-2170)

IYC Medicare Plus (ET-4113)

L

Letter of Medical Need (ERA Program)

Life Insurance Application/Cancellation/Refusal (ET-2304)

Limited Power-of-Attorney for Appeal (ET-4944)

Living Benefits Brochure (ET-2327)

Local Annuitant Health Progam Booklet - 2011 (ET-2156)

Local Annuitant Health Progam Fact Sheet - 2012 (ET-9019)

Long-Term Disability Benefit Claim Form and Instructions (ET-5313)

Long-Term Disability Insurance Folder (ET-5108)

M

Maximum Voluntary Contributions Worksheet (ET-2566)

Medical Expense Account Continuation Election Form (ET-1518)

Medicare Eligibility Statement (ET-4307)

Military Service Credit (ET-4122)

myETF Benefits Quick Start Guide (ET-2167)

N

Name/Address Change (ET-2815) (Fillable Word doc)

Notice of Death for Spouse or Dependent Child (ET-6303)

Notice of Nondiscrimination (ET-8108)

O

Ombudsperson Program Brochure (ET-8935)

Ombudsperson Services Fact Sheet (ET-8934)

Order to Divide Wisconsin Deferred Compensation Program Account (ET-2367)(Fillable Word doc)

Our Wisconsin Retirement System: Strong for Wisconsin (ET-7100)

P

Personal Use Statement (ERA Program)

Pharmacy Benefits Program Fact Sheet (ET-8933)

Q

QDRO - Foreign Jurisdiction Order to Divide WRS Benefits (ET-4935)

QDRO - Military Service Certification and Affidavit (ET-4322)
This form should be used only in a divorce.

QDRO - Order to Divide WRS Benefits (ET-4926)

R

Reciprocity (ET-7364)

Reciprocity: Election (ET-7366)

Reciprocity: Employee Summary (ET-7356)

Request to Copy or Inspect Medical Information (ET-2421)

Resolution to Increase Prior Creditable Service (ET-1311)

Retirement Annuity Option Change Application (ET-4319)

Retirement Estimate Request (ET-4207)

S

Separation Benefits (ET-3101)

Sick Leave Conversion Credit Brochure (ET-4132)

Sick Leave Escrow Application (ET-4305)

Sick Leave Re-enrollment Application (ET-4317)

State IYC Access Plan - State Employees (ET-2112)

Steps to Prepare for Medicare (ET-4114)

Survivor Certification of Eligibility for Public Safety Officer Survivor Benefit Tax Exemption (ET-6330)

T

Tax Liability on WRS Benefits (ET-4125)

U

USERRA Certification (ET-4560)

Federal USERRA Notice

V

Vendor Privacy & Security Incident Report (ET-8945) (Fillable Word doc)

W

Waiver of Part-Time Elected Service (ET-4303)

Wisconsin Public Employers Group Life Insurance Plan (ET-2101)

Wisconsin Retirement System Fact Sheet (ET-8901)

WPE Coinsurance IYC Access Health Plan (ET-2160)

WPE Deductible IYC Access Health Plan (ET-2162)

WPE Traditional IYC Access Health Plan (ET-2131)

Retirement Appointment Options (ET-7114)

WRS Guide to Retirement (ET-4133)

WRS News (ET-7402)

Y

Your Benefit Handbook (ET-2119)

 

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