Completion of Substance Abuse Treatment

Document Number: UCB-18105-E

Description: Substance abuse providers use this form to notify the Department of Workforce Development, Unemployment Insurance Division (DWD/UI) of an individual's completion of the mandated substance abuse treatment.

Comments: Please return completed form by mail, fax or encrypted email within 7 days of the date of completion of treatment to: Unemployment Insurance, P.O. Box 7905, Madison, WI 53707, Fax: (608) 260-2506, Email: UIDrugTest@dwd.wi.gov. Failure to return the form could result in denial of benefits to the claimant and no payment for services will be processed.

This form is available as an electronic Microsoft Word document that can be filled out on your computer to save and email, or it can be printed and then mailed or faxed. If you are unable to use the Microsoft Word document, a fillable PDF is also provided.

Content Contact: UI Pre-Employment Drug Screening Notification

Document Attachments:

UCB-18105-E (Electronic Microsoft Word Version - doc/69 KB)

UCB-18105-E (Electronic Adobe Version - pdf/19 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.

Completion of Substance Abuse Treatment

Contact Information