Employer Forms, Brochures and Publications

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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