Notice: While unemployment insurance payments have not been impacted by the federal government shutdown at this time, November benefits for FoodShare members have been reduced due to the ongoing shutdown. For questions about using FoodShare benefits, information about benefit delays, or help finding food assistance resources, visit:
Wisconsin Department of Health Services' FoodShare webpage
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Document Number: UCT-18688-1-E
Description: This form is used by employers when making a payment plan request, or to update an existing payment plan..
Comments: This form is available as a fillable PDF form. Please fill out business and contact information, the required fields in the payment plan request, and click the submit button when you would like to submit the request to a collections specialist.
Content Contact: Collection Specialist or (608) 266-9700
Document Attachment: UCT-18688-1-E (Electronic Version - pdf/114 KB)
NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.