ESBD_478994_1767365556362_SOL_EXH_F.4_AP152.pdf
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- Attached to
- Agilent Blanket Service
- Solicitation number
- 405-26R0002002
- Issued by
- Texas
About this file
This document is the Application for Texas Identification Number (AP-152), a form issued by the Texas Comptroller of Public Accounts that must be completed by any person, business, partnership, corporation, or organization seeking to bill Texas state agencies for goods, services, refunds, or other compensation. The form is used to establish a Texas Identification Number (TIN) required for all payment requests submitted by state agencies. The application must be submitted to the specific state agency with which the applicant intends to conduct business. Completion requirements vary depending on whether this is a new account or an existing account with an assigned TIN; new accounts require completion of Sections 1-5, while existing accounts require only Sections 1, 2, and 5.
The form requires comprehensive payee information including the applicant's legal name, mailing address, telephone number, and taxpayer identification (EIN, SSN, or ITIN). Applicants must select an ownership code that accurately reflects their business structure, including options for sole proprietors, partnerships, corporations, professional associations, governmental entities, and foreign entities. The application includes fields for payment assignments to third parties, current Texas tax reporting status, and ownership details with supporting documentation requirements. The Texas Comptroller of Public Accounts processes the application and assigns a unique TIN, which becomes mandatory for all subsequent maintenance and payment requests from state agencies. For assistance with application completion, applicants may contact the state agency providing the form or the Payment Services division at 512-936-8138 or tins.mail@cpa.texas.gov.
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| Payee | Information | (Please type or print) | ||||||||
| 4. | Name | of | payee | (Individual | or | business | to | be | paid) |
5. Mailing address where you want to receive payments
6. (Optional)
7. (Optional)
8. (Optional)
9. City State ZIP code
10.
Payee telephone number (Area code and number)
Security type code ( 0, 1, 2 )
Zone code
| 2. | Texas | Identification | Number | (TIN) | - | Indicate the type of number you are providing to be used for your TIN | |
| Employer | Identification | Number | (EIN) | (9 digits) |
(SSN)Social Security number (9 digits)
Individual Taxpayer Identification Number (ITIN) (9 digits)
| Comptroller's | assigned | number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) | |
| Current | Texas | Identification | Number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) |
| 3. | Are | you | currently | reporting | any | Texas | tax | to | the | Comptroller's |
| office | such | as | sales | tax | or | franchise | tax? | YES | NO |
Enter the number indicated
If "YES," enter Texas Taxpayer Number
1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5
For Comptroller's use only
11. Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.
L - Texas Limited Partnership:
If checked, enter the
Texas File Number
Owner's name
T - Texas Corporation:
If checked, enter the Texas File Number
SSN / ITIN (9 digits) A - Professional Association:
If checked, enter the Texas File Number
If checked, enter the exas File Number
C - Professional Corporation:
T
Name
SSN / ITIN / EIN (9 digits)
Name
SSN / ITIN / EIN (9 digits)
I - Individual Recipient (not owning a business)
| S | - | Sole | Ownership | (Individual | owning | a | business): | If | checked, |
| enter | the | owner's | name | and | Social | Security | number | (SSN) |
P - Partnership: If checked, enter two partner's names and
| Social | Security | numbers | (SSN). | If | a | partner | is | a | corporation, | use |
| the | corporation's | Employer | Identification | Number | (EIN). |
O - Out-of-State Corporation
G - Governmental Entity
U - State agency / University
F - Financial Institution
R - Foreign (out of U.S.A.)
N - Other: If checked, explain.
12. Payment Assignment? YES NO Note: A copy of the assignment agreement between payees must be attached.
Assignee name
Assignee TIN Assignment date
13. Comments Authorized signature (Applicant or authorized agent) Date
14.
Agency name Prepared by Phone (Area code and number)
15.
AP-152
(Rev.8-21/18)
Application for Texas Identification Number
• See instructions on back
Se ct io n
Se ct io n
Se ct io n
Se ct io n
Se ct io n
Form AP-152 (Back)(Rev.8-21/18)
Application for Texas Identification Number Instructions G L E N N H E G A R T E X A S C O M P T R O L L E R O F P U B L I C A C C O U N T S
| Who | Must | Submit | This | Application | ||||||||||||||
| This | application | must | be | submitted | by | every | person | (sole | owner, | individual | recipient, | partnership, | corporation | or | other | organization) | who | intends |
to bill agencies of the state government for goods, services provided, refunds, public assistance, etc. When the application is processed by the
| state | agency | with | which | the | applicant | is | conducting | business, | a | Texas | Identification | Number | (TIN) | will | be | assigned | and | will | be | required | on | all |
| maintenance | and | payment | requests | submitted | by | state | agencies. |
| For | Assistance | ||||||||||||||||||||
| For | assistance | in | completing | this | application, | contact | the | state | agency | from | which | the | form | was | received | or | obtained. | The | applicant | must | return |
the completed application to the state agency with which the applicant is conducting business.
| Note | to | State | Agencies: When this form is used to set up additional mail codes after a TIN has been set up, Sections 1, 2 and 5 must be com- | |||||||||||||||
| pleted. | See | FMX's | TexPayment | Resource | (TPR) | for | additional | information. | Call | Payment | Services | at | 512-936-8138 | or | by | at | ||
| tins.mail@cpa.texas.gov | if | your | agency | has | questions | about | the | TPR | requirements | and/or | needs | assistance | for | their | payees | in | completing | the |
application or with processing the form.
| General | Instructions | ||||||||||||||||||
| • | Do | not | use | dashes | when | entering | the | 9-digit | Employer | Identification | Number | (EIN), | Social | Security | number | (SSN), | or | Individual | Taxpayer |
| Identification | Number | (ITIN). |
| • | Disclosure | of | your | Social | Security | number | is | required. | This | disclosure | requirement | has | been | adopted | under | the | Federal | Privacy | Act | of | 1974 | |
| (5 | U.S.C.A. | sec. | 552a(note)(West | 1977), | the | Tax | Reform | Act | of | 1976 | (42 | U.S.C.A. | sec. | 405(c)(2)(C) | (West | 1992), | TEX. | GOV'T. | CODE | ANN. | ||
| sec. | 403.055 | (Vernon | 2005) | and | TEX. | GOV'T. | CODE | ANN. | sec. | 403.056 | (Vernon | 2005). | Your | Social | Security | number | will | be | used | to | help | the |
| Texas | Comptroller | of | Public | Accounts | administer | the | state's | tax | laws | and | for | other | purposes. | See | Op | Tex. | Att'y | Gen. | No. | H-1255 | (1978). |
Specific Instructions Item 1: Is this a new account?
Select YES if the applicant has never received a payment from a Texas state agency and does not have an assigned TIN.
Select NO if the applicant has received payments from a Texas state agency and already has an assigned TIN.
Mail Code / Agency number – Will be entered by the state agency that processes the application.
| Section | 1 | — | Texas | Identification | Number | |||||||||||||||
| EIN: | For | all | ownership | codes | other | than | Individual | Recipient | listed | in | Section | 3, | enter | a | 9-digit | Employer | Identification | Number | (EIN) | is- |
| sued | by | the | Internal | Revenue | Service | (IRS). | ||||||||||||||||
| SSN: | For | individuals | or | sole | owners | who | choose | not | to | apply | with | their | EIN, | enter | your | 9-digit | Social | Security | number | (SSN) | issued | by |
| the | Social | Security | Administration. | ||||||||||||||||||
| ITIN: | For | individuals | who | do | not | qualify | for | an | SSN, | enter | your | 9-digit | Individual | Taxpayer | Identification | Number | (ITIN) | issued | by | the | IRS. |
| Comptroller | Assigned | Number | (FOR | STATE | AGENCY | USE | ONLY): | This | 11-digit | Comptroller-assigned | number | is | provided | to | a | state |
agency that needs to pay a foreign entity or a foreign individual who does not have an EIN, SSN or ITIN.
Current Texas Identification Number (FOR STATE AGENCY USE ONLY): The 11-digit current Comptroller-assigned TIN.
| Section | 2 | — | Payee | Information | ||||||||||||||||||
| Items | 4-8: | Enter | the | complete | name | and | mailing | address | where | payments | are | to | be | received. | Names | of | individuals | must | be | entered | first | name |
| first, | middle | initial | (if | applicable), | last | name, | suffix | (if | applicable). | The | name | must | not | include | a | period | (.), | comma | (,) | or | percent | sign |
| (%). | Each | line | cannot | exceed | 50 | characters | including | spaces. | If | the | name | is | more | than | 50 | characters, | continue | the | name | in | Item | 5 |
and begin the address in Item 6.
Item 9: Enter the city, state and ZIP code.
Item 10: Enter the payee telephone number.
SIC code / Security type code / Zone code – These fields will be completed by the state agency that will process the application.
| Section | 3 | — | Ownership | Codes | |||||||||||||||||
| Item | 11: | Check | the | box | next | to | the | appropriate | ownership | code | and | enter | additional | information | requested | by | the | selected | code. | Check | only |
| one | box | in | this | section. | The | Texas | Secretary | of | State's | office | may | be | contacted | at | 512-463-5555 | for | information | regarding | Texas |
| File | Number | required | for | codes | L, | T, | A | and | C. |
Section 4 — Payment Assignment Item 12: Select YES if the payee is assigning its payments to a third party and the state agency that will process the application has ap-
| proved | the | assignment | request. | Also, | complete | the | following: |
| • Assignee | name: Provide the assignee’s name as listed on the assignment agreement. A copy of the agreement must be |
attached.
| • Assignee | TIN: Provide the assignee’s EIN if it is a business entity or an SSN or ITIN for an individual. |
| • Assignment | date: Provide the date the assignment agreement was signed. |
Select NO if the payee is not assigning its payments to a third party.
| Section | 5 | — | Comments | and | Identification | ||||||||||||||||
| Item | 13: | Enter | any | additional | information | that | may | be | helpful | in | processing | this | application. | Items | 14 | and | 15 | are | for | identification | purposes. |
| Always | complete | the | identification | section, | including | comments | and | authorized | signature. | ||||||||||||
| Item | 14: | Authorized | signature | and | Date. | Sign | the | application, | as | required | by | the | state | agency | that | will | process | the | form. | Enter | the |
date signed.
Item 15: Agency name, Prepared by, Phone: Will be entered by the state agency that will process the application.
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.
https://fmx.cpa.texas.gov/fm/pubs/payment/ mailto: tins.mail@cpa.texas.gov
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| IntUse2: AGENCY USE ONLY |
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| IntUse1: AGENCY USE ONLY |
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| IntUse3: AGENCY USE ONLY |
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File details come from the government source that posted it. Updated .