Number Sort ascending | Title | Description | Audience |
---|---|---|---|
ET-2500l | Termination Checklist For Local Employees | A checklist for local employers to use when an employee is terminating employment. |
Local Employer |
ET-2500D | Termination Checklist Due to Employee Death | A checklist for state employers to use when an employee is terminating due to retirement. |
State Employer |
ET-2500 | Termination Checklist For Retiring State Employees | A checklist for state employers to use when an employee is terminating due to retirement. |
State Employer |
ET-2440 | County Jailer Election of Protective or General Category Status | Local county employers, please distribute this form to your jailers so they can record their decision to be either a general category employee or a protective category employee for WRS benefit purposes. |
Active Employee, Local Employer |
ET-2366 | Income Continuation Insurance Application--Local Employee | Complete and then submit to your employer to apply for income continuation insurance. |
Active Employee, Local Employer |
ET-2340 | Automatic Premium Conversion Waiver/Revocation of Waiver | Complete this form to waive your participation in automatic premium conversion, or to revoke a waiver of premium conversion that you filed previously. |
Active Employee, Local Employer, State Employer |
ET-2331 | Health Insurance Application/Change for Retirees | Retirees, enroll in health insurance or change your coverage. |
Retiree, Other Benefit Recipient, Local Employer, State Employer |
ET-2319 | Rehired Annuitant | WRS annuitants who have met all terms and conditions associated with having a valid termination and meeting the minimum break in service requirement may return to work for a WRS employer. |
Retiree, Local Employer, State Employer |
ET-2314a | Model COBRA Subsidy Notice | This is the Model Notice for COBRA Continuation Subsidy under the American Rescue Plan [ARP] Act of 2021. Employers please note that information for qualified beneficiaries must be completed. |
Local Employer, State Employer |
ET-2314 | Request for Treatment as an Assistance Eligible Individual | The American Rescue Plan Act of 2021 (ARP) subsidizes the full COBRA premium for “Assistance Eligible Individuals” for periods of coverage from April 1, 2021 through September 30, 2021. |
Local Employer, State Employer |