Complete this form using results from your most recent health care provider visit to earn credit for the 2021 Well Wisconsin Program. The form must be submitted by October 8, 2021.
ET-8929
Fact Sheet
Active Employee /
Retiree /
Local Employer /
State Employer
The ASLCC and SHICC programs were created by Wis. Stat. § 40.05 (4) (b). The ASLCC Program was first authorized in 1972; the SHICC program was first authorized in 1995.