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Colorado Catastrophic Health Insurance - Employee Election
Extracted from PDF file 2023-colorado-form-dr-0811.pdf, last modified August 2013Catastrophic Health Insurance - Employee Election
DR 0811 (08/30/13) COLORADO DEPARTMENT OF REVENUE Denver, CO 80261-0005 *130811==19999* Employees Election Regarding Catastrophic Health Insurance Employee's Last Name First Name Middle Initial SSN Employer's Name Employer's Address City State Zip I hereby certify that I am an employee of the above listed employer who has offered catastrophic health insurance to employees under the provisions of §10-16-116, C.R.S. I further certify that I reside in the State of Colorado and that the above listed employer does not offer to provide me with any other form of health insurance. I hereby elect to have this catastrophic health insurance withheld from my wages by my employer on a Colorado pretax basis. This election will continue in effect until canceled by myself, by my employer or by the insurance carrier, or until I cease to be employed by this employer. Signature Date (MM/DD/YY)
Form DR 0811
More about the Colorado Form DR 0811 Individual Income Tax TY 2023
This form is to certify that you are an employee of the above listed employer who has offered catastrophic health insurance to employees under the provisions of ยง10-16-116, C.R.S. You further certify that I reside in the State of Colorado and that the above listed employer does not offer to provide me with any other form of health insurance. You can hereby elect to have this catastrophic health insurance withheld from your wages by your employer on a Colorado pretax basis
We last updated the Catastrophic Health Insurance - Employee Election in February 2024, so this is the latest version of Form DR 0811, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form DR 0811 directly from TaxFormFinder. You can print other Colorado tax forms here.
Other Colorado Individual Income Tax Forms:
TaxFormFinder has an additional 64 Colorado income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form 104 | Colorado Income Tax Return |
| Form 104EP | Individual Estimated Income Tax Payment Form |
| Form 104CR | Tax Credits for Individuals |
| Form DR 0900 | Payment Voucher for Individuals |
| Form 104X | Amended Income Tax Return Form |
View all 65 Colorado Income Tax Forms
Form Sources:
Colorado usually releases forms for the current tax year between January and April. We last updated Colorado Form DR 0811 from the Department of Revenue in February 2024.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
Historical Past-Year Versions of Colorado Form DR 0811
We have a total of thirteen past-year versions of Form DR 0811 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2011 Form DR 0811
DR 0811
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