Data Transfer Request For Other Agency Accounts Program Form
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1Department of Revenue Use Only
DATA TRANSFER REQUEST FOR
Date Received
O R E G O N
D E PA R T M E N T
OTHER AGENCY ACCOUNTS PROGRAM
O F R E V E N U E
• Type or print neatly. • Send white and canary copies to the Department of Revenue with your transfer medium.
• Keep pink copy for your records.
To be completed by agency requesting data transfer —
Assigning Agency Name
Contact Person
Telephone Number
(
)
Agency Address
Program Code
Transfer Medium —
Format —
Type of Account —
(Must be labelled “OAA Accounts” and include the total number of records
ASCII
Restricted
and your agency name.)
Diskette (ITB Job 628R)
Delimited
Unrestricted
number of records
Cartridge (ITA Job 789R)
Other
number of records
Tape (ITA Job 789R)
number of records
Cartridge/Tape Number (if applicable): _________
Other Requests — (additional blank tranfer media must be enclosed)
OAA Monthly Payment Processing (ITA Job 991M)
(ITC Job 011R). Reconciliation requested on:
Paper
Diskette
Cartridge (enclosed)
Delivery Specifications —
Call ___________________________________ for pick-up
(Name/phone No.)
Return by shuttle
Return by regular mail
New accounts are certified to be liquidated debts.
Date Sent to Revenue
Signature Authorizing Data Transfer
Title
X
If you have questions or need help, call the OAA program at (503) 945-8199.
Send top two copies of Data Transfer Request and your data transfer medium to:
OTHER AGENCY ACCOUNTS PROGRAM
OREGON DEPARTMENT OF REVENUE
955 CENTER STREET NE, RM 255
SALEM OR 97310-2501
To be completed by Department of Revenue —
Received in OAA on . . . . . . . . . . . . . . . . . . . . . . . . . .
by
Received in Computer Services on . . . . . . . . . . . . . .
by
Processed in Computer Services on . . . . . . . . . . . . .
by
Returned to OAA on . . . . . . . . . . . . . . . . . . . . . . . . . .
by
Received from Computer Services on . . . . . . . . . . . .
by
# processed
# suspended
Suspense worked on . . . . . . . . . . . . . . . . . . . . . . . . .
by
# records deleted
Reconciliation request sent to Computer Services on
by
# records _________
Reconciliation request returned to OAA on . . . . . . . .
by
Medium returned to agency on . . . . . . . . . . . . . . . . . .
by
150-702-001 (Rev. 6-97)
Distribution: White—OAA File Copy
Canary—Computer Services Work Copy
Pink—Requesting Agency
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