Independent Contractor (Ic) Checklist (Page 6 of 10) in pdf

STATE OF CALIFORNIA - CALIFORNIA STATE UNIVERSITY SAN MARCOS

PAYEE DATA RECORD

(CSUSM 204 Rev. 02/11)

Requirement to Complete Payee Data Record, CSUSM 204

A completed Payee Data Record, CSUSM 204, is required for payments to all non-governmental entities and will be kept on file at

each State agency. Since each State agency with which you do business must have a separate CSUSM 204 on file, it is possible

for a payee to receive this form from various State agencies.

Payees who do not wish to complete the CSUSM 204 may elect to not do business with the State. If the payee does not complete

the CSUSM 204 and the required payee data is not otherwise provided, payment may be reduced for federal backup withholding

and nonresident State income tax withholding. Amounts reported on Information Returns (1099) are in accordance with the

Internal Revenue Code and the California Revenue and Taxation Code.

Enter the payee’s legal business name. Sole proprietorships must also include the owner’s full name. An individual must list

his/her full name. The mailing address should be the address at which the payee chooses to receive correspondence. Do not

enter payment address or lock box information here.

Check the box that corresponds to the payee business type. Check only one box. Corporations must check the box that

identifies the type of corporation. The State of California requires that all parties entering into business transactions that may

lead to payment(s) from the State provide their Taxpayer Identification Number (TIN). The TIN is required by the California

Revenue and Taxation Code Section 18646 to facilitate tax compliance enforcement activities and the preparation of Form 1099

and other information returns as required by the Internal Revenue Code Section 6109(a).

Check the box(es) that best describes payee's primary business, e.g. if payee provides goods and services, please check both

boxes.

Small business and DVBE Information. Check all boxes that apply and provide OSBCR Certification Number.

California resident or nonresident:

A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the

Secretary of State to do business in California.

A partnership is considered a resident partnership if it has a permanent place of business in California. An estate is a resident if

the decedent was a California resident at time of death. A trust is a resident if at least one trustee is a California resident.

For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary

or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally,

an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident.

However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

Payments to all nonresidents may be subject to withholding. Nonresident payees performing services in California or receiving

rent, lease, or royalty payments from property (real or personal) located in California may have 7% of their total payments

withheld for State income taxes.

For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below:

Withholding Services and Compliance Section:

1-888-792-4900

E-mail address:

wscs.gen@ftb.ca.gov

For hearing impaired with TDD, call:

1-800-822-6268

Website:

Neither a U.S. Citizen nor a Permanent Resident Alien for federal tax purposes:

Federal tax withholding regulations differ significantly from California tax withholding requirements. Nonresident alien payees

performing services in the United States may have 30% of their total payments withheld for Federal income taxes. Additional

paperwork may have to be filled out.

Refer to the IRS website for tax analysis and forms:

Provide the name, title, signature, and telephone number of the individual completing this form. Provide the date the form was

completed.

This section must be completed by the State agency requesting the CSUSM 204.

Privacy Statement

Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, State, or local governmental agency,

which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure

is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.

It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is

not provided is subject to federal backup withholding and State law imposes noncompliance penalties of up to $20,000.

You have the right to access records containing your personal information, such as your SSN. To exercise that right, please

contact the business services unit or the accounts payable unit of the State agency(ies) with which you transact that business.

All questions should be referred to the requesting State agency listed page 2 of this form.

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Independent Contractor (Ic) Checklist Page 6

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