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Numeric List of ET- Forms and Brochures

The following list contains ET- forms for member use. If the form number you are seeking does not begin with ET-, we suggest you search for it by program or alphabetically.

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.

ET-1000s Forms

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

(ET-1311) Resolution to Increase Prior Creditable Service

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

(ET-1518) Medical Expense Account Continuation Election Form

ET-2000s Forms

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

(ET-2106) Income Continuation Insurance - State

(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

(ET-2112) State IYC Access Plan

(ET-2119) Your Benefit Handbook

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

(ET-2123) Additional Contributions

(ET-2124) Investment Earnings Distribution Report

(ET-2129) Income Continuation Insurance - Local

(ET-2131) WPE Traditional IYC Access Health Plan

(ET-2156) Local Annuitant Health Program Brochure - 2011

(ET-2160) WPE Coinsurance IYC Access Health Plan

(ET-2162) WPE Deductible IYC Access Health Plan

(ET-2164) Group Life Insurance Plan Monthly Rates

(ET-2166) Domestic Partner Benefits

(ET-2167) myETF Benefits Quick Start Guide

(ET-2170) IYC Access Plan HDHP

(ET-2207) Buying Other Governmental Service

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

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

(ET-2305) Evidence of Insurability

(ET-2306) Conversion Information - Life Insurance

(ET-2307) Income Continuation Insurance Application-State

(ET-2313) Canceling Variable Participation

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

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

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

(ET-2327) Living Benefits Brochure

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

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

(ET-2366) Income Continuation Insurance Application-Local

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

(ET-2371) Affidavit of Domestic Partners

(ET-2372) Affidavit of Termination of Domestic Partners

(ET-2405) ETF Insurance Complaint Form

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

(ET-2545) Additional Contributions Remittance

(ET-2566) Maximum Voluntary Contributions Worksheet

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

ET-3000s Forms

(ET-3101) Separation Benefits

ET-4000s Forms

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

(ET-4105) Information for Rehired Annuitants

(ET-4106) Applying For Your Retirement Benefit

(ET-4107) Calculating Your Retirement Benefits

(ET-4112) Group Health Insurance

(ET-4113) IYC Medicare Plus

(ET-4114) Steps to Prepare for Medicare

(ET-4116) Information for Retirees

(ET-4117) Choosing an Annuity Option

(ET-4121) Buying Creditable Service

(ET-4122) Military Service Credit

(ET-4133) WRS Guide to Retirement

(ET-4125) Tax Liability on WRS Benefits

(ET-4132) Sick Leave Conversion Credit Brochure

(ET-4207) Retirement Estimate Request

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

(ET-4305) Sick Leave Escrow Application

(ET-4307) Medicare Eligibility Statement

(ET-4310) Income Tax Withholding Election

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

(ET-4317) Sick Leave Re-enrollment Application

(ET-4319) Retirement Annuity Option Change Application

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

(ET-4560) USERRA Certification

Federal USERRA Notice

(ET-4814) Employer Verification of Health Insurance Coverage

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

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

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

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

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

(ET-4938) Appeal Form

(ET-4943) Administrative Appeal Process

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

ET-5000s Forms

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

(ET-5107) Disability Benefits Folder

(ET-5108) Long-Term Disability Insurance Folder

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

ET-6000s Forms

(ET-6101) Death Benefits

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

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

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

ET-7000s Forms

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

(ET-7114) Retirement Appointment Options

(ET-7116) It's Your Benefit Newsletter

(ET-7282) Direct Deposit Authorization - Monthly

(ET-7301) Benefit Information Request

(ET-7333) Explanation of Annual Statement of Benefits

(ET-7356) Reciprocity: Employee Summary

(ET-7364) Reciprocity

(ET-7366) Reciprocity: Election

(ET-7402) WRS News

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

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

ET-8000s Forms

(ET-8108) Notice of Nondiscrimination

(ET-8501) Comprehensive Annual Financial Report

(ET-8873) IRS Benefits and Compensation Limits

(ET-8900) Employee Reimbursement Accounts Fact Sheet

(ET-8901) Wisconsin Retirement System Fact Sheet

(ET-8902) Group Health Insurance Fact Sheet

(ET-8903) Group Life Insurance Fact Sheet

(ET-8904) Deferred Compensation Program Fact Sheet

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

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

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

(ET-8933) Pharmacy Benefits Program Fact Sheet

(ET-8934) Ombudsperson Services Fact Sheet

(ET-8935) Ombudsperson Program Brochure

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

ET-9000s Forms

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



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