Form Ftb 2282 Pc - Initial Request To Participate
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Date: ___________________
Initial Request to Participate
Interagency Intercept Collection Program
DIVISION OF ACCOUNTING AND REPORTING
BUREAU OF STATE TAX ADMINISTRATION
ATTN OFFSET COORDINATOR
OFFICE OF THE STATE CONTROLLER
PO BOX 942850
SACRAMENTO CA 94250-5880
Fax: 916.327.2563
The ____________________________________________________ requests authorization to participate
Agency/College
in the Interagency Intercept Collections Program beginning with the 20
process year.
We are a:
State agency
We request intercept services for delinquent debts owed to our agency. Our request and debts meet
the legal requirements for participation (California Government Code Sections 12419.5, 12419.10,
12419.11, and 12419.12; State Administrative Manual Sections 8790.1 through 8790.8; California
Revenue and Taxation Code Section 19551).
College
We request intercept services for delinquent debts owed to our college/post-secondary education
institution. These debts may include delinquent registration, tuition, bad check fees, library fines,
or other permitted debts. Our request and debts meet the legal requirements for participation
(California Government Code Sections 12419.7, 12419.9, and 12419.12; State Administration
Manual Sections 8790.1 through 8790.8).
City or county agency
We request intercept services for delinquent debts owed to our agency. These debts may include
property taxes, delinquent fines, bails, vehicle parking penalties, court-ordered payments, or other
permitted debts. Our request and debts meet the legal requirements for participation (California
Government Code Sections 12419.8 and 12419.10).
Special district
We request intercept services for overdue and unpaid bridge toll or high-occupancy toll lane fees,
any interest, fine, penalty, bail, collection fee, or other charge on account of nonpayment of the
bridge toll or high-occupancy toll lane fees. (California Government Code Section 12419.12)
FTB 2282 PC (REV 08-2013) PAGE 1
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Parent category: Financial