|
Title |
Form No. |
Print/Order |
| Application |
UWS1245 |
Online |
| Application - Continuation |
UW1249 |
Online |
| Application - Pilot Coverage |
HRIS-B1247 |
Online |
| Application - Pilot History |
HRIS-B1248 |
Online |
| Beneficiary Designation |
UWS1245 |
Online |
| Certificate |
UWS-B1250 |
Online |
| Fact Sheet |
UWS1246 |
Online |
| Travel Assistance |
UWS1255 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application - Participant Enrollment Form |
NA |
www.wdc457.org or call the Madison Office at 877-457-9327, Option 2 |
| Application - Withdrawal |
NA |
Call the Madison Office at 877-457-9327, Option 2 |
| Beneficiary Designation |
NA |
Change your beneficiary on line by logging into your WDC account at www.wdc457.org or call the Madison Office at 877-457-9327, option 2 to obtain the form via mail or email |
| Catch-Up Election |
NA |
Call the Madison Office at 877-457-9327, Option 2 |
| Fact Sheet |
NA |
www.wdc457.org |
| Investment Performance |
NA |
www.wdc457.org |
| Participation Agreement |
NA |
https://wisconsin.gwrs.com/static/Wisconsin/pdf/planhighlights.pdf |
| Payment Estimate |
NA |
Call the Madison Office at 877-457-9327, Option 2 |
|
|
Title |
Form No. |
Print/Order |
| Affidavit for Insurance Purposes |
UWS 93 |
Online |
| Application |
E11444 |
Online |
| Application - Continuation |
E11472-0011 |
Online |
| Beneficiary Designation |
None |
Online |
| Brochure |
E11549 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
OSER/UW Application |
Online |
| Application - Continuation |
UWS-61 |
Online |
| Plan Summary |
DNTB-8373b |
Online |
| HMO Handbook |
DC-83445-7, -9999 |
Online |
| PPO Handbook |
DC-83445-8, -18 |
Online |
| Supplemental Handbook |
DC-83445-9, -19 |
Online |
| Provider Directory HMO |
STD-NEW/Ortho (Combo) |
Online |
| Provider Directory PPO |
HD-PPO/Ortho(Combo) |
Online |
|
| Domestic Partner Affidavit/Termination |
| Domestic Partnership -- Affidavit |
UWS50 |
Online |
| Domestic Partnership--Termination |
UWS51 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
FBMC/WIS/0803 |
Online |
| Application - Continuation |
ET-1518 |
Online |
| Automatic Premium Conversion Waiver/Revocation of Waiver |
ET-2340 |
Online |
| Change in Status |
None |
Online |
| Claim |
None |
Online |
| Rapid Refund |
None |
Online |
|
|
Title |
Form No. |
Print/Order |
| Affidavit for Insurance Purposes |
UWS 93 |
Online |
| Application/Change Form |
ET-2301 |
Online |
| Application - Continuation for 2009 |
ET-2311 |
Online |
| Application - Continuation for 2010 |
ET-2311 |
Online |
| Authorization to Disclose Non-Medical Individual Personal Information |
ET-7414 |
Online |
| Complaint Form |
ET-2405 |
Online |
| Health Insurance Election for Military Personnel |
ET-2350 |
Online |
| Health Insurance Rate Addition to the Quick File |
UW1054 |
Online |
| It's Your Choice Booklet (Classified/Unclassified) |
ET-2107 |
Online |
| It's Your Choice Booklet (Graduate Assistant) |
ET-2127 |
Online |
| WPS Standard Plan Booklet |
ET-2112 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
ET-2307 |
Online |
| Order |
| Application - Evidence of Insurability |
ET-2308 |
Online |
| Certificate/Booklet |
ET-2106 |
Online |
| Order |
| Employer Statement |
ET-5351 |
Online |
| Report of Employment Earnings |
ET-5901 |
Online |
| Sick Leave Election Usage |
UW1456 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
03-30539 |
Online |
| Application - Conversion |
03-30573 |
Online |
| Application - Evidence of Insurability |
03-30538 |
Online |
| Beneficiary Designation |
F53232 |
Online |
| Premium Waiver Request |
UWSB-1225-6 |
Online |
| Transfer of Ownership |
F66318-2 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Annual Leave Conversion Form: WSEU and WLEA |
UW1089 |
Online |
| Annual Leave Conversion Form: Non-Rep, WPEC Exempt, WSP Exempt, SEIEU, SEA, PERSA Exempt |
UW1089 |
Online |
| Annual Leave Conversion Form: WEAC |
UW1089 |
Online |
| Annual Leave Conversion Form: WPEC Non-Exempt, WSP Non-Exempt, PERSA Non-Exempt |
UW1089 |
Online |
| Unclassified Leave Accounting Request |
UW1397 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
ET-2304 |
Online |
| Application - Evidence of Insurability |
ET-2305 |
Online |
| Application - Continuation |
ET-2154 |
Online |
| Application - Conversion |
ET-2306 |
Online |
| Beneficiary Designation |
ET-2320 |
Online |
| Certificate/Booklet |
ET-2101 |
Online |
| Limited Power of Attorney Appeal |
ET-4944 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
None |
Online |
|
| Payroll |
| Title |
Form No. |
Print/Order |
| Check Correction |
UW1383 |
Online |
| Direct Deposit Authorization |
UW1032 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Commuter Benefits - Enrollment/Change |
None |
Online |
| Commuter Benefits - Request for Reimbursement |
None |
Online |
| Vanpool - Enrollment/Change |
None |
Order |
| Vanpool - Waiver (PDF) |
UW1079 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Additional Contributions Election |
UW1069 |
Online |
| Additional Contributions |
ET-2123 |
Online |
| Beneficiary Designation |
ET-2320 |
Online |
| Buying Creditable Service |
ET-4121 |
Online |
| Calculating Your Retirement Benefits |
ET-4107 |
Online |
| Choosing an Annuity Option |
ET-4117 |
Online |
| Death Benefits |
ET-6101 |
Online |
| Disability Benefits |
ET-5102 |
Online |
| Group Health Insurance Book for Retirees |
ET-4112 |
Online |
| Group Life Ins. After You Terminate Employment |
ET-4104 |
Online |
| How Divorce Can Affect Your WRS Benefits |
ET-4925 |
Online |
| How Participation In The Variable Trust Fund Affects Your WRS Benefits |
ET-4930 |
Online |
| Information for Retirees |
ET-4116 |
Online |
| Military Service Credit |
ET-4122 |
Online |
| Rehired Annuitant Election |
ET-2319 |
Online |
| Separation Benefits |
ET-3101 |
Online |
| Tax Liability on WRS Benefits |
ET-4125 |
Online |
| Your Benefit Handbook |
ET-2119 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Authorization for Purchase and Request for Change-Series I |
None |
Online |
| Authorization for Purchase and Request for Change-Series EE |
None |
Online |
|
|
Title |
Form No. |
Print/Order |
| EdVest Enrollment Kit |
None |
Order |
| Additional Investments |
None |
Online |
| Beneficiary Designation |
None |
Online |
| Distribution |
None |
Online |
| Home Address, Bank, Contribution Change |
None |
Online |
| Investment Change |
None |
Online |
| Rollover |
None |
Online |
| Successor Account (as Custodian) Owner Designation |
None |
Online |
|
|
Title |
Form No. |
Print/Order |
| Beneficiary Designation |
None |
Order |
| Salary Reduction Agreement |
HRIS-B3231 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Duplicate W-2, 1042-S and Reportable Fellowship 1099 (Multiple Request) (Excel) |
UW1179 |
Online |
| Duplicate W-2, 1042-S and Reportable Fellowship 1099 (Single Request) |
UW1180 |
Online |
| Earned Income Credit - Wisconsin |
W-5 |
Online |
| Employee Campus/Home Address Change |
UW1035 |
Online |
| Employee's Withholding Agreement - Wisconsin |
WT-4A |
Online |
| Employee's Withholding Allowance Certificate - Federal |
W4 (UW1389) |
Online |
| International Tax Packet |
UW1469 |
Online |
| Statement of Minnesota Residency - Wisconsin 2009 |
W-222 |
Online |
| Working Families Tax Exemption - Wisconsin |
WT-4B |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application - Continuation |
UWS1206 |
Online |
| Application - Conversion |
EdF 68525 |
Online |
| Beneficiary Designation |
F. 59786 |
Online |
| Certificate |
03-30564 |
Online |
| Living Benefit |
F. 45067 |
Online |
| Transfer of Ownership |
F66318-2 |
Online |
|
|
Title |
Form No. |
Print/Order |
| Application |
GA-1314 |
Online |
| Application - Conversion |
None |
Online |
| Application - Evidence of Insurability |
GA-1129 |
Online |
| Beneficiary Designation |
GA-562 |
Online |
| Brochure |
GA-1117 |
Online |
| Certificate |
UW/GIC/05 |
Online |
|
Vision Benefits |
Title |
Form No. |
Print/Order |
| Application |
EF4t |
Online |
| Application - Continuation |
EF2t |
Online |
| OptumHealth Vision Summary |
N/A |
Online |
|
