State of Rhode Island Magnetic Media Filing Requirements
STATE OF RHODE ISLAND
DIVISION OF TAXATION
ONE CAPITOL HILL
PROVIDENCE, RI 02908
TRANSMITTAL FORM
FOR THE REPORTING OF TAX WITHHELD ON MAGNETIC MEDIA
Federal Employer Identification Number: ___________________________________
Employer Name & Address: _______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Contact Person:
Name: ________________________________________________Title: ___________________________________
Phone Number: _______________________________________________________
SUBMITTED MATERIAL (INCLUDING CARTRIDGES, TAPES AND DISKETTES) WILL NOT BE RETURNED.
Record formats outlined in the SSA MMREF-1 Magnetic Media Reporting amendments or revisions thereto and by
accessing the SSA website at
, selecting "forms and publications" and choosing MMREF-1.
The following information is REQUIRED:
1. Reporting media:
Cartridge ________ Tape ________ Diskette ________
2. Number of individual records: ________________
3. Total amount of state withholding: _____________________________________
Complete the following if tape or cartridge:
4. Recording Mode: EBCDIC ______________________ ASCII _____________________
5. Record Length: ___________________
6. Blocking Factor: __________________
7. Labels: Yes _______ No ______
NOTE: THIS FORM (or the form included within the remittance booklet) MUST BE SUBMITTED WITH YOUR TAPE, CARTRIDGE OR DISKETTE.
IF MORE THAN ONE TAPE, CARTRIDGE OR DISKETTE IS BEING SENT FOR THIS FILING YEAR, INDICATE IF IT IS A REPLACEMENT OR AN
ADDITION.
Signature: _________________________________________ Title: ______________________ Date: ____________
Form RI-Magnetic Media
Rev 11/02
4