​February 1, 2022

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 2021

General Information

• Form is available in MyDORGov
• Due date – March 15, 2022
• County/Municipal Clerk must electronically file (e-file) this report
• The reported values are used to calculate the 2023 adjustment to County and Municipal Aid. A county/municipality will not be eligible for this aid adjustment if the form is not submitted timely.

Form Information

Each county/municipality must report:

• Number of eligible deceased personnel
• Number of surviving spouses/dependents and their age as of January 1, 2021
• Premiums paid during 2021

Questions?

Contact us at lgs@wisconsin.gov.