Form 54-103 - Texas 9-1-1 Wireless Emergency Service Fee Report
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1b.
54-103
PRINT FORM
CLEAR FORM
(Rev.5-10/6)
Texas 9-1-1 Wireless Emergency Service Fee Report
91100
a. T Code
Type or print.
Do not write in shaded areas.
c. Taxpayer number
d. Filing period
f. Due date
e.
h.
Blacken this box if your mailing address has
1.
g. Name and mailing address (Make any necessary name or address changes below.)
changed. Show changes by preprinted information.
Blacken this box if you are no longer in business,
2.
and enter the date you went out of business below.
Month
Day
Year
i.
j.
Instructions for Completing Texas 9-1-1 Wireless Emergency Service Fee Report
WHO MUST FILE -
Wireless service providers must file this report and remit the 9-1-1 wireless
You have certain rights under Chapters 552 and
emergency service fees due each month.
559, Government Code, to review, request and correct
information we have on file about you. Contact us at
Any person who sells prepaid wireless telecommuncations services must file report 54-104 and remit
the address or phone number listed on this form.
the prepaid 9-1-1 wireless emergency fee.
WHEN TO FILE -
File this report and remit the fees due on or before the 20th day of the month
following the end of the month in which the fees are collected. If the due date falls on a Saturday,
Sunday or legal holiday, the next business day is the due date. You must file a report, even if no
9-1-1 wireless emergency service fee is due.
DEFINITIONS
"9-1-1 wireless emergency service fee" -
The fee collected by a wireless service provider from its
subscribers at a rate of $0.50 per month for each wireless telecommunications connection.
"Wireless service provider" -
A provider of commercial mobile service under Section 332(d),
Electronic reporting and payment options
Federal Telecommunications Act of 1996 (47 U.S.C. Section 151 et seq.), Federal Communications
are available 24 hours a day, 7 days a week.
Commission rules, and the Omnibus Budget Reconciliation Act of 1993 (Pub. L. No. 103-66), and
Have this form available when you log on.
includes a provider of wireless two-way communication service, radio-telephone communications
related to cellular telephone service, network radio access lines or the equivalent, and personal
communication service. The term does not include a provider of: a service whose users do not have
access to 9-1-1 service; a communication channel used only for data transmission; a wireless
roaming service or other non-local radio access line service; or a private telecommunications service.
Report only fees you actually collected during the filing period.
Do not enter negative figures.
1. Number of wireless connections on which fee was collected
1.
2. Gross 9-1-1 wireless service fee collected
(Multiply Item 1 by $0.50) (Report dollars and cents)
2.
3. Administrative fee retained
(Service providers may retain an administrative fee
of 1% of the gross 9-1-1 wireless emergency service fee collected.)
3.
4. Net 9-1-1 wireless service fee due
(Subtract Item 3 from Item 2)
4.
54-103 (Rev.5-10/6)
5. Penalty due -
If this report is filed or the fee due is paid after the due date, enter penalty.
(If 1-30 days late, enter 5% of the amount in Item 4.
If more than 30 days late, enter 10% of the amount in Item 4.)
5.
6. Interest due
(If any fee is unpaid 61 days after the due date, enter interest on the amount in Item 4.
Calculate interest at the rate published online at ,
or call the Comptroller's office at (877) 447-2834 for the applicable interest rate.)
6.
7. TOTAL AMOUNT DUE AND PAYABLE
(Sum of Items 4, 5 and 6)
7.
Taxpayer name
k.
l.
T Code
Taxpayer number
Period
I declare that the information in this document and any attachments is true and correct
to the best of my knowledge and belief.
Taxpayer or duly authorized agent
Make the amount in Item 7
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
payable to:
P.O. Box 149356
Daytime phone
Date
STATE COMPTROLLER
Austin, TX 78714-9356
For information about the 9-1-1 wireless emergency service fee,
call
or
.
(800) 252-5555
(512) 463-4600
111 A
Details are also available online at
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