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State of ConnecticutState Of Connecticut Office of the State Comptroller Healthcare Policy & Benefit Services Division 55 Elm Street Hartford, CT 061061775 www.osc.ct.govEmergency Room Co-payment
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This form is submitted to the IRS.
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Employers are required to file this form with the IRS.
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You can fill out this form electronically or by mail.
What is the purpose of submit this form to?
The purpose of this form is to report information about employees' wages and taxes.
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Information such as wages, tips, and other compensation must be reported on this form.
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