Employee Forms (http://www.bussvc.wisc.edu/ecbs/emp-forms-listing-page.pdf)
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Accidental Death and Dismemberment Dental and Excess Medical (EPIC) Dental Insurance Plan Disability-Wisconsin Retirement System Domestic Partner Affidavit/Termination EdVest Employee Reimbursement Accounts Health Insurance Income Continuation Insurance Individual and Family Group Life Insurance Leave Benefits Long Term Care Insurance Accidental Death and Dismemberment (AD&D) Title Application Application for Continuation Application--Pilots Application History--Pilots Beneficiary Designation Fact Sheet Certificate/Booklet Travel Assistance Summary Top Dental and Excess Medical (EPIC) Title Application Application for Continuation Beneficiary Designation Certificate/Booklet Top Dental Insurance Title Application Application for Continuation HMO Booklet/Certificate Plan Summary PPO Booklet/Certificate Provider Directory--HMO Provider Directory--PPO Supplemental Booklet/Certificate Top Disability--Wisconsin Retirement System Title Beneficiary Designation Benefit Information Request/Estimate Long Term Disability Insurance--Claim Filing Instructions Sick Leave Election--Duty Disability, Long-Term Disability & Wisconsin Retirement System Disability Top Domestic Partner Affidavit/Termination Title Domestic Partnership--Affidavit Domestic Partnership--Termination Top EdVest Title Additional Investments Beneficiary Designation Distribution Request EdVest Enrollment Kit Home Address, Bank, Contribution Change Investment Change Rollover Successor Account (as Custodian) Owner Designation Top
Pre-Tax Transportation Savings Bonds State Group Life Insurance Tax Sheltered Annuities UW Employees, Inc. Life Insurance University Insurance Association Life Insurance Vision Benefits Wisconsin Deferred Compensation Wisconsin Retirement System Workers Compensation Payroll Taxes Form No. UWS1245 UW1249 HRIS-B1247 HRIS-B1248 UWS1245 UWS1246 UWS-B1250 UWS1255 Print/Order PDF PDF PDF PDF PDF PDF PDF PDF
Form No. E11444 E11472-0011 None E12061-0312
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Form No. OSER/UWS Application HRIS-B1603 FP/CCD4736 DNTB-8373b FP/BCBSD 4501 STD-NEW/Ortho (Combo) HD-PPO/Ortho (Combo) FP/BCBSD 4501
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Form No. ET-2320 ET-7301 ET-5106 UW1456
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Form No. UWS-50 UWS-51
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Form No. EDACBLD WIBENE WIDIST None WIACR WICHANG WIROLL WISUC
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Employee Reimbursement Accounts (ERA) Title Application Application for Change in Status Application for Continuation Application--Rapid Refund Application--Standard Refund Premium Conversion Waiver/Revocation of Waiver Top Health Insurance Title Application--Classified/Unclassified Application--Graduate Assistant Application--Health Insurance During Military Leave Authorization to Disclose Non-Medical Individual Personal Information It's Your Choice Booklet--Classified/Unclassified It's Your Choice Booklet--Graduate Assistant WPS Standard Plan Booklet/Certificate Top Income Continuation Insurance (ICI) Title Application Application--Evidence of Insurability Application--Sick Leave Usage at Time of Claim Income Continuation Insurance Certificate/Booklet Top Individual and Family Group Life Insurance Title Application Application - Conversion Application - Evidence of Insurability Beneficiary Designation Individual and Family Insurance Booklet Individual and Family Insurance Conversion Booklet Individual and Family Insurance Certificate Plan Summary Top Leave Benefits Title Application--Building Trades Employee Vacation Option Application--Catastrophic Leave, Classified Donor Application--Catastrophic Leave, Classified Recipient Application--Catastrophic Leave, Unclassified Donor Application--Catastrophic Leave, Unclassified Recipient Application--Health Insurance During Military Leave Classified Annual Leave Conversion Options (Non-Rep, WPEC Exempt, WSP Exempt, SEIU, SEA, PERSA Exempt) Classified Annual Leave Conversion Options (WEAC) Classified Annual Leave Conversion Options (WLEA, WSEU, WPEC Non-Exempt, WSP Non-Exempt, and PERSA Non-Exempt) Leave--Family Medical Leave Certification Leave--Intent to Donate Bone Marrow or a Human Organ Leave--Unclassified Leave Employee Report Sick Leave - Conversion at Layoff Request Sick Leave - Escrow Application Sick Leave - Restoration of Leave Application Unclassified Leave Accounting Request Top Long Term Care Insurance (LTC) Title Long Term Care Booklet Top
Form No. FBMC/WIS/0803) None ET-1518 None FMBC/WISC/1203 ET-2340
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Form No. ET-2301 ET-2302 ET-2350 ET-7406 ET-2107 ET-2127 ET-2112
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Form No. ET-2307 ET-2308 UW1456 ET-2106
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Form No. 03-30539 03-30573 03-30538 F.53232 F59114 F4638-11 03-30541 03-30540
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Form No. UW1162 OSER-DCLR-14 OSER-DCLR-12 None None ET-2350 UW1089 UW1205
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UW1205 FMLA UW1259 UW1538 UWS40 ET-4305 UW1139 UW1397
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Form No. None
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Pre-Tax Transportation Title Commuter Benefits - Enrollment/Change Commuter Benefits - Request for Reimbursement Parking - Cancellation Parking - Enrollment Parking - Waiver Vanpool - Enrollment/Change Top Savings Bonds Title Authorization for Purchase and Request for Change-Series I Authorization for Purchase and Request for Change-Series EE Top State Group Life Insurance Title Application Application for Continuation Application--Evidence of Insurability Application--Conversion Beneficiary Designation State Group Life Insurance Program--Certificate/Booklet Top Tax Sheltered Annuities (TSA) Title Beneficiary Designation--find appropriate TSA vendor Salary Reduction Agreement--Fillable Salary Reduction Agreement--Printable Top UW Employees, Inc. Life Insurance Title Application Application--Conversion Application--Evidence of Insurability Beneficiary Designation UW Employees, Inc. Insurance Certificate/Booklet Plan Summary Top University Insurance Association Life Insurance (UIA) Title Application for Continuation & Ballot Beneficiary Designation UIA Certificate/Booklet Top Vision Benefits Title Application OptumHealth Vision Summary Top Wisconsin Deferred Compensation (WDC) Title Application - Participant Enrollment Form Application--Withdrawal
Form No. None FBMC/CBPWISC/0 902 None None UW1079 None
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Form No. SB-2253 E SB-2152 E
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Form No. ET-2304 ET-2154 ET-2305 ET-2306 ET-2320 ET-2101
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Form No. None HRIS-B3231 HRIS-B3231
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Form No. GA-1314 None GA-1129 GA-562 UW/GIC/05 GA-1117
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Form No. UW1443-1 F. 59786 03-30564
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Form No. EF4t N/A
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Print/Order www.wdc457.org or call the Madison Office at 877-457-9327, Option 2 Call the Madison Office at 877-4579327, Option 2 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 Call the Madison Office at 877-4579327, Option 2 www.wdc457.org www.wdc457.org https://wisconsin.gwrs.com/static/Wis consin/pdf/planhighlights.pdf Call the Madison Office at 877-4579327, Option 2
Beneficiary Designation Catch-Up Election Fact Sheet Investment Performance Participation Agreement Payment Estimate Top
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Wisconsin Retirement System (WRS) Title Additional Contribution Election Additional Contributions Additional Contributions-Maximum Voluntary Contributions Worksheet Beneficiary Designation Benefit Information Request/Estimate Buying Creditable Service Calculating Your Retirement Benefits Choosing an Annuity Option Death Benefits Disability Benefits Divorce--How Divorce Can Affect Your WRS Benefits Divorce--Qualified Domestic Relations Order Group Health Insurance Book for Retirees Group Life Ins. After You Terminate Employment Income Tax Withholding Election for Retirees Information for Retirees Military Service Credit Rehired Annuitant Election Separation Benefits Tax Liability on WRS Benefits Variable--Election to Cancel Variable Participation Variable--Election to Participate in the Variable Trust Fund Variable--How Participation Affects Your WRS Benefits Your Benefit Handbook Top Workers Compensation Title Employer's First Report of Injury or Illness Medical Records Release Employee's Work Injury or Illness Report Supervisor's Accident Analysis and Prevention Report WC Timesheet Top Payroll Title Direct Deposit Authorization Employee Campus/Home Address Change--Printable Employee's Withholding Allowance Certificate - Federal Top Taxes Title Domestic Taxes Earned Income Credit - Federal Employee's Withholding Agreement - Wisconsin Employee's Withholding Allowance Certificate Statement of Minnesota Residency - Wisconsin 2008 Statement of Minnesota Residency - Wisconsin 2009 Working Families Tax Exemption - Wisconsin International Taxes Alien Tax Information Request UW1123 Federal Form 8233 Federal Form 8233 Instructions International Tax Packet Revenue Procedure Statement 87-8 Revenue Procedure Statement 87-9 Tax Treaty Table W-8BEN W-9 Top
Form No. UW1069 ET-2123 ET-2566 ET-2320 ET-7301 ET-4121 ET-4107 ET-4117 ET-6101 ET-5102 ET-4925 ET-4926 ET-4112 ET-4104 ET-4310 ET-4116 ET-4122 ET-2319 ET-3101 ET-4125 ET-2313 ET-2356 ET-4930 ET-2119
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Form No. WKC-12 WKC-9488 OSLP-1 WKC-SUP UW1059
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Form No. UW1032 UW1035 W4 (UW1389)
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Form No. W-5 WT-4A W4 (UW1389) W-222 W-222 WT-4B UW1123 IRS-8233 IRS-8233 Instr UW1469 UW1462 UW1463 UW1339 UW1252 W-9
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