5-TWC Substitute W-9 and Direct Deposit Form 1020a.docx
DOCX document 35 KB Posted
- Attached to
- Civil Rights Investigator
- Solicitation number
- 3202600076
- Issued by
- Texas
About this file
This is a Substitute W-9 and Direct Deposit Form issued by the Texas Workforce Commission (TWC) for use by contractors and service providers receiving payments from the State of Texas. The form serves as a tax identification and payment authorization document required for individuals and entities entering into contract relationships with TWC. The form collects essential information including the contractor's legal name, business name if applicable, taxpayer identification number (Social Security Number or Employer Identification Number), federal tax classification, and business designation. Additionally, the form requires documentation of profit or non-profit status, state of jurisdiction for corporations, and partnership information where applicable. The form explicitly requires authorized signature, printed name, and date certification under penalties of perjury before submission.
The Direct Deposit section of the form mandates contractor response regarding payment delivery preferences, requiring contractors to either authorize electronic direct deposit to a specified financial institution, decline direct deposit, or modify existing direct deposit arrangements. Contractors must provide complete financial institution details including routing number, account type, and account number. The form includes certification language whereby contractors authorize the Texas Comptroller of Public Accounts to process electronic payments in compliance with National Automated Clearing House Association rules and acknowledge that the state may reverse erroneous payments. This form is a mandatory prerequisite for payment processing and contract administration for civil rights investigation services and other TWC procurements.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-Form-1-Questions and Answers-WORD-3.15.2023.docx | DOCX document | |
| 2-Form2-Execution of Response-WORD1-3.15.2023.docx | DOCX document | |
| 1-Terms and Conditions 12.2022 (10pt).pdf | ||
| 4-Form4-References-WORD-3.15.2023.docx | DOCX document | |
| 6-Attachment4-Insurance Requirements-WORD-2.28.2023.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
SUBSTITUTE W-9 & DIRECT DEPOSIT FORM
(Print or type in text fields)
Box 1 Box 2 Box 3 Legal Name (as shown on your tax return):
Business Name (if different from Box 1):
Tax Information Mailing Address:
| City: |
| State: |
| Zip: |
| Box 4 |
| Payment Address (if different from Tax Address): |
| City: |
| State: |
| Zip: |
| Phone: |
| Fax: |
| Email: |
| Box 5 |
| Taxpayer Identification Number: |
| Note: Enter the same number used filing your tax return |
Social Security Number (SSN) Employer Identification Number (EIN)
| Box 6 | |
| Federal Tax Classification/ Business Designation: | |
| T=Texas Corporation; C=Professional Corporation; or T/O= Limited Liability Company | |
| A=Professional Assoc. | F=Financial Institution |
| L=Limited Partnership | R=Foreign Corporation |
| P=General Partnership | U=State Agency/University |
| O=Out-of-State Corporation | E=State Employee |
| S=Sole Owner | N= Other |
| G=Government Entity | If Other, please explain: I=Individual Recipient |
| Box 7 |
| Profit Status: |
Profit
Non-Profit
| Box 8 |
| Corporation Info: |
| State of Jurisdiction: |
| File or Charter Number: |
| Box 9 |
| Sole Ownership |
Info:
Sole Owner Name and SSN:
| Box 10 |
| General Partnership Information: |
| Partner 1 Name and SSN/EIN: |
Partner 2 Name and SSN/EIN:
| Box 11 |
| Backup Withholding: |
Please see IRS Website Exempt from Backup Withholding
*Authorized signature is required on page 2.
TWC
Substitute
W-9 and
Direct
Deposit
Form
(1/2020) Page of
Direct Deposit Information (Response Required)
| Box 12 |
| New Account Information (Setups and Changes) |
| I am currently on Direct Deposit and wish to continue. |
| I decline Direct Deposit at this time. |
| New Set-up |
| Change in Direct Deposit Information |
| Cancel My Direct Deposit |
Financial Institution Name: City: State: Zip:
| Financial Institution Routing Number: |
| Type of Account: |
| Account Number: | |
| Checking | Savings |
| Box 13 |
| Existing Account Information (Complete only for direct deposit information change) |
| Financial Institution Routing Number: |
| Type of Account: |
| Account Number: | |
| Checking | Savings |
Box 14 Box 15 Will payments be forwarded to a financial institution outside the United States? Yes No
Certification of TWC Substitute W-9 and Direct Deposit Form
Under penalties of perjury, I certify that:
1) I have provided my correct taxpayer identification number and that;
2) I am not subject to backup withholding as specified on the instruction page for this form and that;
3) I am a US citizen or other US person and that;
4) For Direct Deposit Authorization Setup, Changes or Cancellation I authorize the Texas Comptroller of Public Accounts to deposit my payments from the State of Texas to my financial institution electronically. I understand that the Texas Comptroller of Public Accounts will reverse any payments to my account in error.
I further understand that the Texas Comptroller of Public Accounts will comply at all times with the National Automated Clearing House Association’s rules. For further information on these rules, please contact your financial institution.
Authorized Signature Required:
Printed Name Required: Date Required:
TWC
Substitute
W-9 and
Direct
Deposit
Form
(1/2020) Page of image1.jpeg
File details come from the government source that posted it. Updated .