Fillable External SignLanguageInterpreterPayment Form Sign Language Interpreter Certification and Request for Payment Form

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External SignLanguageInterpreterPayment Form Sign Language Interpreter Certification and Request for Payment Form

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1
Sign Language Interpreter Certication
Interpreter—Follow the steps below to complete this form. Sections 1, 2, and 3 must be
completed prior to the test administration. All information is required.
Test Coordinator—Return this completed form inside the Test Administration Forms Envelope
on test day. If it is not submitted on test day, return to:
ACT Test Administration (58) Phone: 319.337.1510
PO Box 168 Fax: 319.339.3039
Iowa City, IA 52243-0168 Email: testact@act.org
1. Print the administration information:
Examinee’s Name Test Date
Test Center Name Test Center Code Room Name/Number
2. Read the interpreter policies and responsibilities:
Thank you for helping ACT provide an equitable testing opportunity for this examinee.
The following information describes the governing policies and your test day role and
responsibilities:
You may not be a relative or guardian of the examinee. If a relative or guardian
interprets for the examinee, the examinee’s tests will not be scored or the scores will
be canceled.
Comply with standardized testing polices, as directed by test center staff.
Accompany the examinee into the test room and remain with the examinee
throughout the administration.
Interpret all verbal instructions and communications made by staff. Interpret any
questions from examinees to the staff and the staff’s responses to those questions.
Do not interpret any test content.
Do not answer questions about the verbal instructions or test content. If the
examinee has questions, ask a member of the testing staff for the answer.
Do not eat, drink, or use electronic devices of any kind, including cell phones, in the
test room. All electronic devices must be powered off. You may bring snacks and
beverages to consume outside the test room during break.
3. Sign the Interpreter’s Certification Statement:
I certify that I am not related to or the guardian of the examinee named above; I interpreted
the verbal instructions for the examinee named above in accordance with the policies stated
above; and I provided no assistance to the examinee with regard to test content.
Interpreter’s Name (print) Signature Date
4. Have the room supervisor sign the Room Supervisor’s Certification Statement:
I certify that the individual named above interpreted the verbal instructions and complied
with standardized testing procedures under my supervision.
Room Supervisor’s Name (print) Signature Date
5. If requesting payment, complete the Sign Language Interpreter Request for Payment (page 2)
after testing.
6. Give this form to the test coordinator at the end of testing, even if you are not requesting payment.
2
Sign Language Interpreter Request for Payment
Interpreter—Complete this form only if requesting payment. Submit it to the test coordinator
on test day, after testing. Please print. All information is required. Refer to ACT’s compensation
policies.
Test Coordinator—Return this completed form inside the Test Administration Forms Envelope
on test day. If it is not submitted on test day, return to:
ACT Test Administration (58) Phone: 319.337.1510
PO Box 168 Fax: 319.339.3039
Iowa City, IA 52243-0168 Email: testact@act.org
1. Administration information:
Examinee’s Name Test Date
Test Center Name Test Center Code Room Name/Number
2. Method of payment:
Payment to be remitted to the interpreting services company (interpreter’s employer)
Payment to be remitted directly to the interpreter
3. Payee Information:
Interpreter’s Name OR Company Name
Mailing Address
City / State / ZIP
Telephone Number Email Address
4. Interpreter’s Time and Rate:
Start Time: Total Time:
End Time: Hourly Rate:
5. Signatures:
Interpreter's Name (print) Signature Date
Test Coordinator's Name (print) Signature Date
3
Compensation Policy
Note: The interpreter should keep this policy for his or her records.
ACT uses our Supplier Registration and Payment System (SRPS) to pay all test center staff.
A supplier is any individual, organization, or business that provides services for ACT. The test
coordinator, room supervisors, proctors, sign language interpreters, and facility staff (e.g., security
and custodial) are classied as “suppliers.”
All suppliers must create an account in SRPS (https://srps.act.org) and agree to the terms and
conditions in order to work for ACT. ACT reserves the right to update its payment processes and
procedures, including the terms and conditions, at any time. Check the Supplier Registration
and Payment System for any updates or modications.
In the United States, US territories, and Puerto Rico, payments are issued in the form of direct
deposit or pay card. Outside those locations, payment is issued by wire or by check.
Consistent with applicable federal law, ACT characterizes suppliers as independent contractors
for tax purposes. Accordingly, ACT does not withhold income tax, FICA, or other amounts from
payments made to suppliers. 
All payment information is reported by ACT to the IRS and/or other applicable government
agencies as required by law based on the supplier’s country of citizenship and/or residence. As
required by IRS guidelines, ACT issues 1099-MISC forms to all suppliers who are or have ever
been considered United States persons and that receive cumulative payments of at least $600
in a calendar year regardless if the work was performed in the United States or abroad. Suppliers
receiving less than $600 in a calendar year do not receive 1099-MISC forms.
Requesting Payment
When payment is remitted directly to you:
Submit a completed Sign Language Interpreter Request for Payment (page 2) to the test coor-
dinator on test day after testing. Allow several weeks for processing.
Note: You must have a Supplier Registration and Payment System (SRPS) account to receive
payment.
When payment is remitted to the interpreting services company:
1. The interpreter submits a completed Sign Language Interpreter Request for Payment
(page 2) to the test coordinator on test day after testing.
2. The test coordinator submits the form to ACT.
3. The company submits an invoice and a completed W-9 form to ACT.
Note: The company must have a Supplier Registration and Payment System (SRPS) account
to receive payment.
ACT Test Administration (58)
PO Box 168
Iowa City, IA 52243-0168
Fax: 319.339.3039
The test coordinator will provide you with instructions for creating an account in SRPS.
© 2018 by ACT, Inc. All rights reserved FT04003.OPS3629.
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External SignLanguageInterpreterPayment Form Sign Language Interpreter Certification and Request for Payment Form

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Completed 3 July 2020

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