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
Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.
Document Number: WKC-6156-E
Description: This form should be used by insurance companies to request information from the Social Security Administration regarding an injured person.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). An electronic PDF (WKC-6156-E) is also provided for your convenience.
Content Contact: Lynn Weinberger
Document Attachments:
WKC-6156-E (Electronic Version - Word/50 KB)
WKC-6156-E (Electronic Version - pdf/174 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
Sign up for DWD news and updates
A proud partner of the 
network