Last updated: 2/14/2025
Payroll Statement Form {WC112}
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Description
WC112 - PAYROLL STATEMENT FORM. This form is used by employers to report their payroll information for workers' compensation purposes. It covers the period from July 1, 2024, to December 31, 2024, and is filed with the Colorado Division of Workers' Compensation. The form calculates various workers' compensation premiums based on the payroll of employees, including specific rates for executive officers, employees in different job classifications, and premium discounts based on the hazard group. It also includes calculations for modified premiums, standard premiums, and surcharge premiums. The form serves to determine the employer's liability for workers' compensation insurance and ensures that premiums are correctly assessed based on payroll data. Employers must sign the form under penalty of perjury and may be required to have it notarized. The completed form is then submitted electronically to the Division of Workers' Compensation. www.FormsWorkflow.com
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