W-9 Form Printable for Salt Lake Utah 2018-2025

W-9 Form Printable for Salt Lake Utah: What You Should Know

Form will be mailed within 30 days from end date of certification: W-9-in-pdf.pdf. When W-9 Form is Not Complete A failure to provide any of the information required on a W-9 form may result in the failure of a certification, revocation, or refusal to certify a provider's Medicare/Medicaid Plan. Failure to submit the completed form on time may result in the provider's certification being revoked. Failure to respond to a question on the W-9 form by the deadline may cause the W-9 form to be delayed until all questions on the form are answered. Failure to complete and submit the W-9 form may also result in the provider's certification being revoked. The W-9 Form may be filled out in person at any Department of Finance office or by mail at the following mailing addresses within 30 days: Division of Medicare, CPA (Bureau of the Taxation), P.O. Box 83079, Houston, TX 77019‐0790; and Bureau of the Taxation, 1111 West State Street, Room 917, P.O. Box 957, Salt Lake City, Utah 84116. Please provide the following information as required on the completed W-9: The tax year of the provider under review. The address, telephone number and fax number of the provider at the time that the W-9 form was created. Any other personal information that the Provider believes may be necessary. The provider's Social Security Number and the number of individuals with whom medical services were furnished to the provider during the tax year. Information collected during certification is not confidential, but may be used by the IRS and the Provider to process a claim for refund, or a claim for credit, under the Internal Revenue Code. A fee of 5.00 is required for processing the request for confidentiality. A completed W-9 form will be sent to you by first-class mail. Please allow up to 5 business days from the date of receipt for your W-9 to be received. An electronic version of the W-9 form may be accessed via ServiceNow. Please visit to complete your request. Form W-4 (Rev. October 2018) — Medicare Go to to view, download, or print Form.

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