Form Ftb 2049b - Waiver Request Form Page 2

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INSTRUCTIONS
FIDM Waiver Request Form
Purpose
This form is used to request a delay or pardon from participation in the data exchange for 1 to 4 quarters of a
calendar year. The intent of the form is to allow financial institutions time to prepare for participation or to
grow to a size of holding over 250 accounts. Once the ability to participate is on hand or obtainable, the
financial institution is expected to begin participation in the exchange process even though a waiver may have
been previously granted for a longer period of time.
Guidelines for Approval
The Waiver Forms received by the Franchise Tax Board (FTB) are reviewed for approval. Generally, a copy
of the approved Waiver is mailed or faxed to the financial institution within 45 days of the date of receipt.
FTB will consider waivers under any of three conditions:
1. The total number of open accounts held by your institution is less than 250.
2. Your institution does not maintain account information on a computerized system.
3. Time is needed to make system modifications.
Your Institution
Enter your institution’s name exactly how it will be entered on the Election Form, Magnetic Media Transmittal
and the data exchange file when you begin participation.
Action
This section of the form allows you to request a full or partial calendar year waiver by quarters. When
requesting a partial year waiver it may be helpful to look at the data exchange due date in the chart below and
scan over to the related quarter to determine how to complete the Action Box.
Quarter
Quarter Months
FTB Inquiry File
Method 1 & 2
Mail Date (Meth 2)
Data Exchange
Due
st
1
Qtr
Jan, Feb, Mar
Apr 15
May 30
nd
2
Qtr
Apr, May, Jun
July 15
Aug 30
rd
3
Qtr
Jul, Aug, Sep
Oct 15
Nov 30
th
4
Qtr
Oct, Nov, Dec
Jan 15
Feb 28
Contact/Phone
Name and number of the person within your organization designated to answer questions regarding the
Financial Institution Data Match (FIDM)
FEIN
Federal Employer Identification Number
Authorized Representative
Officer or executive of your organization
FIDM Call Site (916) 845-6304
FTB 2049B (REV 03-2000) SIDE 2

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