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.