1095-C Reissue Request Form
Please use this form to request only 1095-C tax forms.
Please complete this form, print and sign it, then fax it to Employee services at 303-860-4299. Or, mail it directly to Employee Services:
1800 Grant St.
Denver, CO 80203
We will mail a replacement 1095-C no later than four business days from receipt of this completed form.
Last updated: 2017
Download this form below