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Use form STD 205, Payee Data Record Supplement to provide a remittance address if different from the mailing address for information returns, or make subsequent changes to the remittance address. Section 2 – Entity Type.
1 sty 2012 · Payee Data Record (STD.204) Third Party Liability and Recovery Division (TPLRD) may process a payment request to reimburse overpayments, misdirected payments, and duplicate payments, made by health insurance carriers, providers, Medi-Cal beneficiaries, and attorneys.
GENERAL INSTRUCTIONS. Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6. Prompt return of this fully completed form will prevent delays when processing payments.
A completed Payee Data Record (STD. 204) must be obtained from a supplier prior to executing any procurement if the supplier is not a government entity.
The purpose of the STD. 204 form is to obtain payee information for income tax reporting and to ensure tax compliance with federal and state law. The STD. 204 is required for any non-governmental entity or individual entering into a transaction that may lead to a payment from the state.
GENERAL INSTRUCTIONS. Type or print the information on the Payee Data Record, STD 204 form. Sign, date, and return to the state agency/department office address shown in Section 6. Prompt return of this fully completed form will prevent delays when processing payments.
A completed Payee Data Record, STD. 204, is required for payments to all non-governmental entities and will be kept on file at each State agency. Since each State agency with which you do business must have a separate STD. 204 on file, it is possible for a payee to receive this form from various State agencies.
