Number Title Description Audience
ET-4112 Group Health Insurance

This brochure includes general information about health insurance through ETF.

 Active Employee, Retiree, Local Employer, State Employer
ET-4303 Waiver of Part-Time Elected Service

Form for elected officials to irrevocably waive further participation in the WRS for current, and any future, service as an elected official that does not exceed 1,044 hours per year.

 Active Employee, Local Employer, State Employer
ET-4560 USERRA Certification

Once an employee returns to work with his or her pre-military leave of absence employer, the employer is required to submit this form along with a copy of the appropriate military paperwork.

 Active Employee, Local Employer, State Employer
ET-4620 Employee/Employer Certification Annuitant Continuant Coverage--Private Pension Fund

This application is intended for insured employees who are terminating private pension employment, who may qualify to continue life insurance coverage.

 Active Employee, Local Employer, State Employer
ET-4702 Post Retirement Benefit Adjustments Historical Summary

Historical summary of retirement fund adjustments and dividends.

 Active Employee, Retiree, Other Benefit Recipient, Local Employer, State Employer
ET-5306 Request for Disability Premium Waiver

Employers should submit this form when first aware that an insured employee is unable to work due to illness or injury and will be unable to perform any work or to engage in any occupation for an indefinite period.

 Local Employer, State Employer
ET-5351 Income Continuation Insurance Employer Statement

Employer report to verify eligibility for an income continuation insurance claim.

 Local Employer, State Employer
ET-5901 Income Continuation Insurance Report of Employment and Earnings

Employers, complete this form to notify ETF of a claimant’s change in work status and/or earnings paid to the individual after the elimination period.

 Local Employer, State Employer
ET-6329 Employer Certification of Eligibility for Public Safety Officer Survivor Benefit Tax Exemption

Employer certification that a WRS annuity or lump-sum payment made to the survivor of the member named in this form may be eligible for an income tax exemption.

 Local Employer, State Employer
ET-7118a Service to Our Members 2017

Snapshot of ETF-administered services in a year.

 Active Employee, Retiree, Local Employer, State Employer