Form 54-100 - Texas 9-1-1 Emergency Service Fee Report
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454-100
b.
(Rev.2-10/3)
PRINT FORM
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Texas 9-1-1 Emergency Service Fee Report
Local Exchange Service Provider / Business Service User
92180
a. T Code
Do not write in shaded areas.
Type or print
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
j.
i.
You have certain rights under Chapters 552 and
559, Government Code, to review, request and correct
Instructions for Completing the
information we have on file about you. Contact us at
the address or phone number listed on this form.
Texas 9-1-1 Emergency Service Fee Report for
Local Exchange Service Providers / Business Service Users
WHO MUST FILE -
Local exchange service providers and business service users must file this report
and remit the 9-1-1 emergency service fee due for local exchange access (landline) service.
WHEN TO FILE -
File this report and remit the fee due on or before the 30th day following the end of
the month in which the fees were 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 emergency
Electronic reporting and payment options
service fee is due.
are available 24 hours a day, 7 days a week.
Have this form available when you log on.
GENERAL INSTRUCTIONS
Do not enter negative figures.
You must file the district supplement (Form 54-101) with this report.
Report only fees you actually collected during the filing period.
Definitions on back.
1. Total number of access lines on which service fees were collected
(Enter the total number of local exchange access lines/equivalent local exchange access lines on
which you actually
the fee.) (Same as Item 5 on the district supplement, Form 54-101.)
1.
collected
2. Gross 9-1-1 service fee collected
(Enter the total amount of fees
.)
collected
(Same as Item 6 of the district supplement, Form 54-101.)
2.
3. Administrative fee retained
(Service providers/ business service users may retain an administrative fee of 1% of the gross 9-1-1
emergency service fees collected.) (Same as Item 7 of the district supplement, Form 54-101.)
3.
4. Net amount due
4.
(Enter the net service fee due. Same as Item 8 on the district supplement, Form 54-101.)
54-100 (Rev.2-10/3)
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 toll free 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 assistance with any 9-1-1 emergency service fee question,
(800) 252-5555
(512) 463-4600
call
or
.
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Details are also available online at
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