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: ERD-13521-E
Description: This form should be used to file a complaint of discharge, retaliation or discrimination under any of the five laws regarding employment protection for people who report elder abuse or certain other similar concerns, or cooperate with government agencies regulating the health care industry.
Comments: This form must be signed by Complainant or authorized representative.
Content Contact: Equal Rights Information
Document Attachments:
ERD-13521-E (Electronic Version - Word/118 KB)
ERD-13521 (Print Version - pdf/31 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
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