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  2. Forms Repository
  3. UCB-18107-E, Weekly Certification of Willingness to Attend/Enroll in Substance Abuse Treatment

Weekly Certification of Willingness to Attend/Enroll in Substance Abuse Treatment

Document Number: UCB-18107-E

Description: The claimant uses this form to notify the Department of Workforce Development, Division of Unemployment Insurance (DWD/UI) of his/her intent to enroll in and attend treatment when treatment becomes available.

Comments: Please print, sign and return completed form by mail or fax within 7 days of the close of the week for which you are certifying to: Unemployment Insurance, P.O. Box 7905, Madison, WI 53707, Fax: (608) 260-2506. Failure to respond may result in denial of benefits.

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

Content Contact: Benefit Operations Staff

Document Attachments:

UCB-18107-E (Electronic Microsoft Word Version - doc/68 KB)

UCB-18107-E (Electronic Adobe Version - pdf/17 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.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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