Nebraska Department of Insurance
NEW YORK PREMIUM TAX FORMS
These forms are to be used only if your company is domiciled in New York.
Please pick your company's line of insurance from the following list. Each form is a seperate file and must be downloaded seperately. If you do not find your line of insurance, please contact Martha Hettenbaugh at 402-471-2201.
Property and Casualty Insurer
- This packet contains the following forms:
Life and Health Insurer
- This packet contains the following forms:
- State Filing Checklist and Instructions
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Comprehensive Health Insurance Pool (CHIP)
- Nebraska Small Employer Health Reinsurance Program (NSEHRP)
- Request for Fraud Contact and Suspected Fraudulent Claim Report
Health Maintenance Organization
- This packet contains the following forms:
- State Filing Checklist and Instructions
- Annual Premium Tax Return Instructions
- Annual Premium Tax Return
- Quarterly Premium Tax Return
- Comprehensive Health Insurance Pool (CHIP)
- Nebraska Small Employer Health Reinsurance Program (NSEHRP)
- Request for Fraud Contact and Suspected Fraudulent Claim Report
Title Company