Data Transfer Request For Other Agency Accounts Program Form - Oregon Department Of Revenue

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Data Transfer Request for
DepaRTmenT of Revenue use only
Date received
other agency accounts program
To be completed by agency requesting data transfer
Contact person
Assigning agency name
Telephone number
(
)
Agency address
Program code
Type of medium used for transfer:
file format :
FTS (ITA Job 628R)
Fixed—ASCII
number of records _______________________________
FTS directory: / _________________________________________________________
Comma Delimited
Transfer file name (FTS): _____________________________________________
Diskette (ITB Job 628R)
number of records _______________________________
other Requests:
Reconciliation Request (ITC Job 011R)
Please place my text format reconciliation on the following medium:
FTS Directory: /_____________________________________
Paper
CD
Date sent to Revenue
new accounts are certified to be liquidated debts.
If you have questions or need help, contact the OAA Program Analyst at 503-945-8771.
oregon Department of Revenue
Please fax or mail a copy of this completed form to:
attn: oaa—program analyst II
955 Center st ne
salem oR 97301-2555
fax: 503-947-2050
To be completed by Department of Revenue
Request received in OAA on: ..................................... ____________ by ____________
File validated and/or request sent
to oaa directory/IT Services on: ............................. ____________ by ____________
Completed by IT Services on: ................................... ____________ by ____________
Suspense received on: .............................................. ____________ by ____________
# suspended: ________________________
Suspense worked on: ................................................ ____________ by ____________
# deleted: ___________________________
Completed reconciliation received on: ...................... ____________ by ____________
# of records:_________________________
Medium/suspense/reconciliation returned
to agency on: ......................................................... ____________ by ____________
150-702-001 (Rev. 06-07)

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