The Government Alliance to
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| Name of State, county, locality or governmental entity. | |
| Annual revenue amount. | |
| Contact Information: | |
| Name of contact | |
| Title | |
| Phone number | |
| Email Address | |
| Payment Information: | |
| Number of non-payroll disbursing systems in your state or locality. | |
| Is your payment/disbursing system centralized? | |
| If yes, do you disburse for all agencies? Universities? Other instrumentalities such as port or water authorities? Please list number and designation of instrumentality or agency for which the payments are centralized. | |
| If not centralized please list number and designation of disbursement systems. | |
| Please provide the year for which information on the following questions is provided. | |
| Annual dollar amount of purchases on purchase cards. | |
| Annual dollar amount of non-payroll disbursements. | |
| Annual dollar amount of payments for goods, if able to capture. | |
| Annual dollar amount for services, if able to capture. | |
| Total annual vendor payments. | |
| Total number of vendors annually | |
| Are non-payroll miscellaneous payments (reimbursements, retirement benefits, etc..) made through the payroll or other disbursement system. | |
Reporting Information: |
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| Do your vendor records capture the tax identification number for all records? | |
| Do you capture vendor address information? | |
| Can you estimate a cost of the increase in annual information reporting for all vendors? | |
Withholding Questions: |
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| Do you believe your current system can withhold 3% on all payments made for goods and services, and remit this amount to the federal government? | |
| If your system cannot handle the additional withholding transactions, can you estimate a cost to retrofit the system? | |
| Do you believe your system can exempt certain payments (needs based programs) without manual intervention? | |
Additional Information: |
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| Please provide any additional problems that the 3% withholding and associated information reporting will entail. | |
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