Forms & Resources

Employee Forms & Documents

• Form NDW-4 (Reciprocity Exemption for MN & MT Residents Working in ND)
• Form W-4MN (MN Withholding Allowance & Exemption Certificate)
• Form MW-4 (MT Employee’s Withholding Allowance & Exemption Certificate)
• Youth Employment in ND Handout
• ND Employment and Age Certificate – Minors
• Advance Payroll Deduction Form
• Stop Payment Payroll Deduction Form

Dental & Vision Insurance

• 2023 VSP Standard Summary of Benefits
• 2023 VSP Premium Summary of Benefits
• 2023 VSP ND Doctor Directory
• 2023 VSP SD Doctor Directory
• 2023 VSP MN Doctor Directory
• 2023 VSP Vision Application

Medical & Dependent Care Flexible Spending Accounts (FSA)

• FSA Claim Form
• FSA, HRA, HSA Eligible Expenses

Health Savings Account (HSA)

• Security First Bank HSA Application
• FSA, HRA, HSA Eligible Expenses

AFLAC & Life Insurance

• RSLI Benefit Summary
• AFLAC & RSLI Form

Health Reimbursement Account (HRA)

• ICHRA Claim for Reimbursement

Federal Employment Posters

• Employee Rights Employee Polygraph Protections Act (02/2022)
• Your Rights Under USERRA (05/2022)
• IER Right to Work (04/2019)
• E-Verify Participation (08/2017)

State of North Dakota Employment Posters

• Workforce Safety & Insurance Certificate of Premium Payment (This poster provided directly to each employer from WSI)
• Workforce Safety  Insurance Important Notice to Workers (05/2019)

State of South Dakota Employment Posters

• South Dakota 2023 Minimum Wage

State of Minnesota Employment Posters

• Workers’ Compensation (08/2017)
• Pregnant Workers and New Parents (06/2023)
• Veterans’ Benefits and Services (coming soon)
• Earned Sick and Safe Time (coming soon)

Local Minnesota Employment Posters

• City of Minneapolis Minimum Wage Ordinance and Sick and Safe Time Ordinance (01/2023)
• City of St. Paul Minimum Wage and Earned Sick and Safe Time Ordinance (03/2023)