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| Question | Answer |
|---|---|
| Form Name | Osf Form Vend |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | PAYEE, 9-Digit, w9 oklahoma, E-Mail |
OSF Form VEND (3/05)
REGISTERED _____
STATE OF OKLAHOMA
VENDOR/PAYEE FORM
Change of Address, Additional Address (Page 1 only) Gov. Entity
(Page 1 only)
The State of Oklahoma requires the following information for all new vendors (payees) before any payments can be made. This information is used to establish you in the State’s vendor file. Complete all that applies.
AGENCY SECTION
Agency Name |
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Department of Mental Health and Substance Abuse Services |
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45200 |
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Contact Name |
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Bryan Wiewel |
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1099 Reportable
Status
Add:
Remove:
Attention Paying Agency: Please check the ADD box on the left if payments to this vendor/Payee are represented by Account Codes listed on page 3 of this form. If the vendor is incorrectly showing as 1099 Reportable , check the REMOVE box. The PeopleSoft system requires specific details regarding the type of transaction. Please check the box that applies to this vendor:
1 - Rents |
2 - Royalties |
3 - Prizes & Awards |
6 - Medical & Health Care |
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14 - Gross Proceeds to an Attorney |
If vendor has a PeopleSoft Vendor #, add it here.
VENDOR/PAYEE SECTION (Complete and fax to State Agency)
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(or Individual, or Government Entity) |
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Name on IRS Record (if different from above) |
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VENDOR/PAYEE TIN/SSN # |
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Business Address: |
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(PO Box or Street , City, State, |
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Optional Addresses – check as appropriate: |
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If different, |
Pricing |
Ordering |
Invoicing |
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(PO Box or Street , City, State, |
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Contact Name & Title: |
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If different, |
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(PO Box or Street , City, State, |
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Contact Name & Title: |
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Customer Service Information, if different: |
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Vendors/Payees DO NOT fax to numbers below. The form must be returned to the state agency requesting this information.
State Agency, fax vendor completed and signed form to: For Registered Vendors - - DCS, Attention Rhydonia Sloan, at
OSF/DCS USE ONLY
Date Posted:
By:
Page 1 of 3
OSF Form VEND (3/05)
STATE OF OKLAHOMA VENDOR/PAYEE FORM
SUPPLEMENTAL INFORMATION - ALL VENDORS OR PAYEES
The information below is requested under U.S. Tax Laws. Failure to provide this information may prevent you from being able to do business with the State, or may result in the State having to deduct backup withholding amounts from its remittances to you.
U.S. Taxpayer Identification Number (TIN) |
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If none, but applied for, date applied |
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(This number is also known as Federal Employer Identification Number [FEIN] ) |
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U.S. Social Security Number (SSN) |
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If none, but applied for, date applied |
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Check the box below that best describes your residency status:
Companies: |
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Domestic (U.S.) sole proprietorship |
Domestic (U.S.) partnership |
Domestic (U.S.) corporation |
Domestic (U.S.) other |
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Foreign |
Foreign |
Foreign |
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Foreign
Individuals: |
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Citizen (individual) of the United States |
Resident alien (individual) of the United States |
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**NOTE: IF YOU MARK THIS BOX, WE WILL FORWARD AN INTERNAL REVENUE SERVICE (IRS) FORM
SIGNATURE - AND SUBSTITUTE IRS FORM
Under penalties of perjury, I certify that the above information is correct and that:
1.The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
3.3. I am a U.S. person (including a U.S. resident alien).
Certification Instructions - You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN
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Signature of Vendor Representative or Individual Payee |
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Title of individual signing form for company |
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Vendor/Payee (Same as Company Name from Page 1) |
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Page 2 of 3
IRS Instuctions Regarding 1099 MISC Reporting
IRS Instuctions regarding 1099 MISC reporting are posted on the IRS website at: http://www.irs.gov/instructions/i1099msc/index.html. Reportable payments include (a) royalties or broker payments in lieu of dividends or
Generally, if reportable payments do not fall under Box 1, 2, 3, 6 or 14, use Box 7. Specifically, all payments to physicians and medical corporations must be reported in Box 6. Attorney's fees, including payments to a law firm or other provider of legal services, are reportable in Box 7, except for gross proceeds. Gross proceeds paid to attorneys, under IRC section 6045(f), are reportable in Box 14. These include the total amount paid to an attorney for settlement agreements. These rules apply whether or not the legal services are provided to the payer and whether or not the attorney is exclusive payee (e.g., the attorney's and claimant's names are on one check). However, these rules do not apply to wages paid to attorneys that are reportable on Form
OSF Account Codes for 1099 Reporting - By Category
1 - RENTS |
2 - ROYALTIES |
3 - PRIZES AND AWARDS |
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532110 |
Rent of Office Space |
553170 |
Royalties |
552140 |
Incentive Awards – Monetary & Material |
532120 |
Rent of Land |
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552160 |
Incentive Payments – Oklahoma Horse |
532130 |
Rent of Other Building Space |
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Breeders & Owners |
532140 |
Rent of Equipment and Machinery |
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552170 |
Incentive Payments – Oklahoma Film |
532150 |
Rent of Telecommunications Equip |
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Enhancement Rebate |
532160 |
Rent of Electronic Data Processing |
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Equipment |
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532170 |
Rent of Electronic Data Processing |
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Software |
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532190 |
Other Rents |
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6 - MEDICAL & HEALTH CARE PAYMENTS |
515870 |
Psychiatric & Substance Abuse Hospitals |
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515700 |
Offices of Physicians (except Mental Health Specialists) |
515880 |
Specialty Hospitals (except Psychiatric & Substance Abuse) |
515710 |
Offices of Physicians, Mental Health Specialists |
515890 |
Nursing Care Facilities |
515720 |
Offices of Dentists |
515900 |
Residential Mental Retardation Facilities |
515730 |
Offices of Chiropractors |
515910 |
Residential Mental Health & Substance Abuse Facilities |
515740 |
Offices of Optometrists |
515920 |
Community Care Facilities for the Elderly |
515750 |
Offices of Mental Health Practitioners (except Physicians) |
515930 |
Other Residential Care Facilities |
515760 |
Offices of Physical, Occupational & Speech Therapists, & Audiologists |
537210 |
Laboratory Services & Supplies |
515770 |
Offices of Podiatrists |
551230 |
Medical Services to Indigent (from agencies other than DHS) |
515780 |
Offices of all other Miscellaneous Health Practitioners |
551240 |
Hospital Services to Indigents (from agencies other than DHS) |
515790 |
Family Planning Centers |
551250 |
Other Health Services to Indigents (from agencies other than DHS) |
515800 |
Outpatient Mental Health & Substance Abuse Centers |
515280 |
Surveying & Mapping (except geophysical) Services |
515810 |
Other Outpatient Care Centers |
515290 |
Testing Laboratories |
515820 |
Medical and Diagnostic Laboratories |
515300 |
Interior Design Services |
515830 |
Home Health Care Services |
515310 |
Industrial Design Services |
515840 |
Ambulance Services |
515320 |
Graphic Design Services |
515850 |
All other Ambulatory Health Care Services |
515330 |
Other Specialized Design Services |
515860 |
General Medical & Surgical Hospitals |
515350 |
Custom Computer Programming Services |
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7 - |
515510 |
Photographic Services |
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515010 |
Office of Lawyers |
515520 |
Translation & Interpretation Services |
515020 |
Offices of Notaries |
515530 |
Veterinary Services |
515030 |
Other Legal Services |
515540 |
All other Professional, Scientific and Technical Services |
515060 |
Accounting, Tax Preparation, Bookkeeping & Payroll Services |
515550 |
Management of Companies & Enterprises |
515210 |
Payments for Contract Mentor Services |
515560 |
Office Administrative Services |
515220 |
Architectural Services |
515570 |
Employment Placement Services |
515230 |
Landscape Architectural Services |
515580 |
Business Support Services |
515240 |
Engineering Services |
515590 |
Document Preparation Services |
515250 |
Drafting Services |
515600 |
Telephone Call Centers |
515260 |
Building Inspection Services |
515610 |
Business Service Centers |
515270 |
Geophysical Surveying & Mapping Services |
515620 |
Collection Agencies |
515360 |
Computer Systems Design Services |
515630 |
Credit Bureaus |
515370 |
Computer Facilities Management Services |
515640 |
Other Business Support Services |
515380 |
Other Computer Related Services |
515650 |
Investigation & Security Services |
515400 |
Administrative Management & General Management Consult Services |
515660 |
Educational Services |
515410 |
Human Resources & Executive Search Consulting Services |
515940 |
Individual & Family Services |
515420 |
Marketing Consulting Services |
515950 |
Community Food & Housing & Emergency & Other Relief Services |
515430 |
Process, Physical Distribution, & Logistics Consulting Services |
515960 |
Vocational Rehabilitation Services |
515440 |
Other Management Consulting Services |
515970 |
Child Day Care Services |
515450 |
Environmental Consulting Services |
515980 |
Arts, Entertainment and Recreation |
515460 |
Other Scientific & Technical Consulting Services |
515990 |
Other Services (except Public Administration) |
515470 |
Research & Development in the Physical, Engineering, & Life Sciences |
515490 |
Advertising & Related Services |
515480 |
Research & Development in the Social Sciences & Humanities |
515500 |
Marketing Research & Public Opinion Polling |
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14 - GROSS PROCEEDS TO AN ATTORNEY |
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553180 |
Settlements – Paid To/Thru Attorney |
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Page 3 of 3