The Alabama Quarterly Wage Record Magnetic Media Reporting Guide - Alabama Department Of Industrial Relations Page 4
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23MAGNETIC MEDIA REPORTING REQUEST FOR AUTHORIZATION
AL
(1/02)
Mail to: State of Alabama, Department of Industrial Relations,
Attn: Wage Record Control Clerk, Room 3205
649 Monroe Street, Montgomery, Alabama 36131
MAGNETIC TAPE REPORTING
DISKETTE REPORTING
THIS APPLICATION IS FOR:
FIRM NAME
DATE
ADDRESS
CITY
STATE
ZIP CODE
FEDERAL EMPLOYER IDENTIFICATION NUMBER
PERSON TO CONTACT ABOUT REQUEST
NAME:
TITLE:
STATE EMPLOYER ACCOUNT NUMBER
TELEPHONE:(
)
EXT.:
MAGNETIC REPORTING TO START:
Quarter
Year
DOES THIS ORGANIZATION ACT AS A REPORTING AGENT
YES
NO
IF YES, ESTIMATE NUMBER OF
EMPLOYEES:
EQUIPMENT CARTRIDGE TAPE(S) ONLY
MAKE AND MODEL OF COMPUTER
CODING STRUCTURE
ESTIMATED NUMBER OF EMPLOYERS
ASCII
EBCDIC
CARTRIDGE TAPE (S) ONLY
TAPES
MAKE AND MODEL OF TAPE DRIVE:
LABEL FORMAT
STANDARD
NON-LABELED
DISKETTES
DIAMETER IN INCHES
OPERATING SYSTEM
CAPACITY
TRACKS PER INCH
SIDES / DENSITY
SECTOR SIZE
AUTHORIZED REPRESENTATIVE OF ORGANIZATION REQUESTING APPROVAL:
SIGNATURE:
DATE:
NAME:
TITLE:
PLEASE RETURN TAPES TO:
NAME OF FIRM
ATTENTION
ADDRESS
CITY
STATE
ZIP CODE
**PLEASE MAKE COPIES AND RETAIN ORIGINAL FOR FUTURE USE**
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