I/we understand that the W-2 agency, county or tribal department of human/social services and the state Department of Health and Family Services and the Department of Workforce Development are authorized to request and receive information about me/us under Wisconsin law. Any person, including a financial institution, credit reporting agency, employer, or educational institution is authorized to release this information, under Wisconsin Statue Section 46.25 (2m):

“The department may request from any person any information it determines appropriate and necessary for the administration of this section, ss. 49.19, 49.46, 49.47 and programs carrying out the purposes of 7 USC 2001 to 2029. Any person in this state shall provide this information within seven days after receiving a request under this subsection.”


I/we understand that information on my previous waegs and employment from the records of the Unemployment Insurance program may be shared with the W-2 agency to verify the accuracy of information in my/our application and waive any objection to this verification.

I/we understand the penalties for giving false information or breaking the program rules. I/we certify, under penalty of law, that all asnwers are correct and complete to the best of my/our knowledge, including information about the citizenship or alien status of each  hosuehold member. I/we agree to provide documents, upon request, to prove

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