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Form DR 4678 Colorado

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Form DR 4678 Colorado

Request for Waiver - Restrictions on Public Benefits

This form, DR 4678 from the Colorado Department of Revenue, outlines the process for applicants seeking a waiver due to restrictions on public benefits. Applicants must provide their full name, birth date, gender, social security number, current residence address, and confirmation of U.S. citizenship or not. If an applicant has been denied a public benefit due to inability to establish lawful presence, they may submit documents verifying their name and proof of lawful presence. Additionally, there is an option for designating a representative with relevant forms of identification and signature. The form must be presented in person at any state Driver License office.

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