Employer Forms

Benefits Administration

Employer Forms

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Employer Approval Of Catastrophic Leave (UWS 421)- Upon receipt and review of an employee's request for Catastrophic Leave, the employer shall complete this form to indicate approval/denial and forward to the Payroll Office for processing.

  • Notice of Eligibility and Rights & Responsibilities (UWS 81) pdf  - this form must be provided to an employee within 5 business days of an employee’s request for a WFMLA and/or FMLA-protected leave; or within 5 business days of learning an employee is eligible for coverage by WFMLA and/or FMLA.
  • Designation Notice (UWS 86) pdf  - this form must be provided to the employee who has requested a WFMLA and/or FMLA-protected leave to let the employee know if the leave is approved and/or if the employee needs to submit any additional information before the leave can be approved.
  • HIPPA Authorization pdf  - complete this form if you (the employer) needs to obtain medical information directly from the health care provider.

ETF requires online submission of Sick Leave Conversion Credits through the online Accumulated Sick Leave System on the ETF’s On-line Network for Employers (ONE) system under “my ETF Benefits”. The online sick leave certification process provided through ETF’s system must be used for all employees. To request access review How to Gain Access and Enter a Sick Leave Certification.

Additional Information and Tools

 

Sick Leave paper certification forms (used prior to 1/1/2014) can be used to check the information entered into ETF One. The forms will not be accepted by ETF and are only available to check the information entered into ETF One.

TASC Transfer Form pdf - Complete this form when an employee, who is enrolled in a Flexible Spending Account or Health Savings Account and is transferring to another State Agency. This form does NOT need to be completed for an employee transferring to another UW institution.