Fallen Protective Services Insurance Report – Available Online

February 12, 2020

To: County Clerks and Treasurers, Municipal Clerks and Treasurers

The Wisconsin Department of Revenue (DOR) posted the following forms in My DOR Government Account (MyDORGov).

  • SL-320C – County Fallen Protective Services Insurance Report
  • SL-320M – Municipal Fallen Protective Services Insurance Report

Under state law (2019 WI Act 19), counties and municipalities must submit this form (SL-320C or SL-320M) if they:

  • Had a police officer, emergency medical services practitioner, or firefighter die in the line of duty
  • Paid hospital, surgical or other health insurance premiums for the surviving spouse and dependent children during 2019

General Information

Form Information

Each county/municipality must report:

  • Number of eligible deceased personnel
  • Number of surviving spouses/dependents and their age as of January 1, 2019
  • Premiums paid during 2019

If you have questions, contact us at lgs@wisconsin.gov.