1095-C Reissue Request Form

Published on University of Colorado (https://www.cu.edu)

1095-C Reissue Request Form [1]

Please use this form to request 1095-C tax forms.

We will email a replacement 1095-C no later than four business days from receipt of this completed form.

First Name *

Last Name *

Email

Address

City

State

Zip Code

Date of Birth *

Month

Day

Year

Tax Year Requested *

Source URL:https://www.cu.edu/employee-services/forms/1095-c-reissue-request-form

Links
[1] https://www.cu.edu/employee-services/forms/1095-c-reissue-request-form