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COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT DIVISION OF WORKERS COMPENSATIONSURCHARGE FORM for the period beginning January 1, 2017, and ending June 30, 2017, Do Not Alter this AddressAddress Change

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01

Start by reading the instructions provided with the surcharge form

02

Gather all the necessary information and documents required to fill out the form

03

Fill in your personal details, such as name, address, and contact information

04

Provide the relevant details about the surcharge, such as the type, amount, and reason for the surcharge

05

Include any supporting documents or evidence that may be required

06

Double-check all the information filled in the form for accuracy and completeness

07

Sign and date the form

08

Submit the completed surcharge form to the designated authority or department

Who needs surcharge form?

01

Businesses or individuals who have incurred additional charges or fees may need to fill out a surcharge form

02

Taxpayers who need to report and pay surcharges imposed by tax authorities

03

Companies or individuals involved in legal proceedings that require the payment of surcharges

04

Individuals who have received a notice or request from a government agency to complete a surcharge form

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