CAL STATE LA
UNIVERSITY AUXILIARY SERVICES, INC.
5151 State University Drive, GE 310
Los Angeles, California 90032
Tel: 323.343.2530
Fax: 323.343.5915
Non Resident Alien Notification Form
All fields must be completed x x
Payee Information
Last Name: ________________________________________
First Name: _________________________ Middle Name: ___________________________
Email Address: _________________________________________________
Please provide an email that you access on a daily or frequent basis. Please print clearly
.
Department:______________________
Check One: Faculty/Staff/GA Consultant Student Assistance
Why we are collecting this information:
Cal State LA UAS, Inc. can not issue payments to you until information regarding your immigration status is
provided. This information will be used to determine your correct withholding allowances for taxation purposes. The
Internal Revenue Service (IRS), the U.S. government tax authority, has issued strict regulations regarding the taxation
and reporting of payments made to non-United States citizens. As a result, Cal State LA UAS, Inc. may be required
to withhold U.S. income tax and file reports with the IRS in connection with any payments made to you.
What to expect:
Within a few days, you will receive an email message at the email address you provided, notifying you to log on to the
GLACIER Online Tax Compliance System. The email will contain the Institution ID and your password required
to log on to the system. For your convenience, Cal State LA UAS, Inc. allows you to provide information and
complete the necessary forms via the internet from any web-accessed computer. YOU MUST LOG ON TO THE
GLACIER ONLINE TAX COMPLIANCE SYSTEM AND PROVIDE THE REQUESTED INFORMATION
Failure
to comply:
I understand that if I do not provide the requested information, Cal State L.A. UAS, Inc. is unable to honor the
withholding exemption and other terms of my tax treaty. The maximum amount of U.S. tax will be withheld from any
payments made to me.
Signature: _________________________________________ Date:_________________________
If you have questions: Contact Financial Reporting Accountant, Alberto Contreras at (323) 343-3568 or email
at acontr134@calstatela.edu.
p
For office use only: x
Tax Administrator: ___________________ Date Received_____________________
Date Email Notification/Password sent: __________________________
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