Premium Tax Forms / State Filing Checklist

For the Year Ended December 31, 2021

ALL FORMS HAVE BEEN UPDATED. PLEASE REVIEW THE NEW FORMS CAREFULLY.
THE DEPARTMENT REQUIRES ELECTRONIC FILING THROUGH OPTINS, WHEN FILING ELECTRONICALLY, YOU MUST USE THE FORMS ON THE OPTINS WEBSITE. 
Please email Fraud contact form to DOI.FraudPrevention@nebraska.gov

Please select your company type from the following list.  Within each company type will be the appropriate forms, a premium tax filing FAQ with information regarding the filing process, and the annual filing checklist.  Each form is a separate file and must be downloaded separately.  If you do not find your line of insurance, please contact the Department at DOI.PremiumTax@nebraska.gov.

Domestic Intergovernmental Risk Management Pools