STD_Form_204_-_205_Business_Docusign_Link.docx

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Attached to
24-25_CIRM_106_Alpha_Clinic_Trial-Dashboard
Solicitation number
0000033465
Issued by
California

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This document is a guide explaining the requirements and purposes of two California state government forms: the STD 204 Payee Data Record and the STD 205 Payee Data Record Supplement. The STD 204 is a mandatory form required for all non-government payees before engaging in transactions that may result in payment from any California state agency. The form, which serves as California's equivalent to the IRS W-9 form, collects essential information including Tax Identification Numbers (TIN), 1099 mailing addresses, business entity types, and California residency status.

The STD 205 is an optional supplementary form that allows suppliers to provide additional information not captured on the STD 204, such as alternate payment addresses, additional location addresses, and organizational contacts. The STD 205 must be submitted alongside a valid STD 204 and must be signed by the same certifier. The document includes links to DocuSign versions of both forms for electronic completion and submission.

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STD 204 - The Payee Data Record

· Per SAM 8422.190[footnoteRef:1], the STD 204 is required for Non-Government payees prior to entering into a transaction that may lead to payment from any State of California Government agency. [1: ]

· The State of California uses the STD 204 in lieu of IRS form W-9. While the STD 204 looks and collects similar information as the W-9, The Supplier Management and Reporting Team (SMaRT) will not accept the W-9 in place of the STD 204.

· The purpose of the form is to collect information with the intent of reporting the payments to any potential 1099 accurately. This includes:

· Tax Identification Number (TIN)

· Mailing Address for 1099

· Business entity type

· California Residency Status

· The supplier must provide a valid address to receive potential 1099 information returns on this form.

STD 205 – The Payee Data Record Supplement

· This form is optional

· The supplier may use this form to provide information that is not presented on the STD 204. This includes:

· Addresses not used to report 1099 payments

· Alternate Payment addresses

· Addresses of additional locations for the supplier

· Organizational Contacts for the supplier

· The STD 205 is not required for supplier to receive payment from a State of California agency.

· The STD 205 must be accompanied by a valid STD 204 when submitted by the supplier. (i.e. the STD 205 will not be accepted without a STD 204 that provides the relevant 1099 information for the supplier)

· The certifier (signee) of the STD 205 must match to certifier of the STD 204.

STD Form 204 Payee Data Form – DocuSign version

STD Form 205 Payee Data Record Supplement - DocuSign Version

File details come from the government source that posted it. Updated .