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Colorado Free Printable  for 2021 Colorado Catastrophic Health Insurance - Employee Election

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Catastrophic Health Insurance - Employee Election
Form DR 0811

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)
Extracted from PDF file 2019-colorado-form-dr-0811.pdf, last modified August 2013

More about the Colorado Form DR 0811 Individual Income Tax

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 2020, and the latest form we have available is for tax year 2019. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Colorado Department of Revenue. You can print other Colorado tax forms here.


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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 DR 0900 Payment Voucher for Individuals
Form 104PN Part-Year/Nonresident Computation Form
Form 104CR Tax Credits for Individuals
Form DR 1778 E-Filer Attachment Form

Download all CO tax forms 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 2020.

Show Sources >

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 nine 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:



TaxFormFinder Disclaimer:

While we do our best to keep our list of Colorado Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

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Source: http://www.taxformfinder.org/colorado/form-dr-0811