STEPHEN F. AUSTIN STATE UNIVERISTY
PO Box 13030, Nacogdoches, TX 75962-3030; FAX: 936-468-4282; Email: purchase@sfasu.edu
PAYEE INFORMATION FORM-SUBSTITUTE W-9
This section required for all entities (PROSPECTIVE EMPLOYEES, please forward this form to traveldesk@sfasu.edu)
1. Name (as shown on your income tax return)
5. Exemptions (codes apply only to certain entities
not individuals)
Enter Exempt Payee Code (if any):
Exemption from FATCA reporting code (if any):
(applies to accounts maintained outside the U.S.)
maintained outside the U.S.)
(Enter foreign city, province or state, foreign postal code, and country)
Federal Employer (EIN)
Individuals complete Part I & IV, Partnerships complete Part II & IV, Corporations or other entities complete Part III & IV
Part I. INDIVIDUALS OR SOLE PROPRIETOR
(Check one of the following)
A. I-Individual (not owning a business)
S-Sole Proprietor of Business (Also provide a SSN on line 4 above, for tax reporting)
S-Single Member LLC (Also provide a SSN on line 4 above, for tax reporting)
*Contact Accounts Payable
Partner’s Name: *SSN/FEIN
Partner’s Name: *SSN/FEIN
P-LLC THAT FILES AS A PARTNERSHIP (provide FEIN in section 1, line 4)
Part III. CORPORATION, LLC THAT FILES AS A CORPORATION, OR OTHER ENTITY
(Check one of the following)
T Texas Corporation or Texas LLC that files as a Corporation
ATexas Professional Association CTexas Professional Corporation LTexas Limited Partnership
RForeign Business (outside the U.S.A.)
NOther
If T, A, C, or L is checked, enter Texas File Number
O Out of State Corp, Out of State LLC that files as a Corp, Out of State Professional Association, Out of State Professional Corp or
Out of State Limited Partnership
GGovernmental Entity UState Agency/University
FFinancial Institution
(Description Required)
Part IV. CERTIFICATION. This section required for all entities
Under penalties of perjury, I certify that the information provided on this form is, to the best of my knowledge, true, correct, and complete
PAYEE SIGNATURE: DATE:
Warning: Failure to provide the correct name and number combination may result in payment being subject to 28% backup withholding
Vendor: Return signed form to the SFA department who sent you the form
Departments: Submit completed form to Procurement, PO Box 13030, 4282 (fax), or purchase@sfasu.edu (email)
Yes No If not, do you qualifiy? Yes No
2. Business Name/disregarded entity name, if different from above
3. Address:
Phone:
City:
State:
Zip:
Email Address:
4. Taxpayer Identification Number (TIN). The TIN provided must match the name given on line 1 and/or 2 to avoid backup withholding.
*SSN or ITIN
Direct Deposit is the preferred method of payment. Click here for Direct Deposit form
Are you a state-certified Historically Underutilized Business (HUB)?
*Disclosure of your Social Security Number is required. Refer to General Instructions, of the State of Texas Application for Texas Identification Number,
http://comptroller.texas.gov/taxes/forms/
SFA Contact Name: Contact's Email Address:
Part II. P-PARTNERSHIP
Enter two partner’s names and Social Security Numbers. If either partner is a corporation, provide the corporation’s FEINs below. Also provide
the partnerships FEIN in section 1, line 4.
C. Nonresident Alien Information If you do not have
a SSN or ITIN, check here
*Contact Accounts Payable
B. Citizenship Status: I attest under penalties of perjury that I am (check one of the following):
1. A citizen or national of the United States. Provide SSN in section 1, line 4
2. A Nonresident Alien (Complete C. below). Provide SSN
or ITIN in section 1, line 4 if applicable
3. A Lawful Permanent Resident. Provide Alien #:
*Contact accountspayable@sfasu.edu for income tax treaty determination and/or W-8 information
Adopted 3/21/17
click to sign
signature
click to edit
Purpose of Form An organization that is
required to file an information return with the
Internal Revenue Service (IRS) must obtain your
correct Taxpayer Identification Number (TIN) to
report income paid to you. The TIN is either the
payee’s Social Security Number (SSN) or Employer
Identification Number (EIN) or, for foreign
individuals residing but not working inside the
United States, an Individual Taxpayer
Identification Number. Nonresident alien
information must be obtained to determine the
payee’s tax status for compliance with IRS
withholding and reporting requirements. The
additional information for other payee types is
needed to satisfy State of Texas requirements for
establishing vendor records.
Taxpayer Name and Number Specific
Instructions:
To prevent payments from being subject to
backup withholding, you must provide a correct
TIN. A TIN is considered incorrect if the name and
TIN combination does not match or cannot be
found on IRS or Social Security Administration
(SSA) records.
Name As an individual, you must generally
provide the name shown on your social security
card. However, if you have changed your last
name, for instance, due to marriage, without
informing the Social Security Administration of the
name change, please enter your first name, the
last name shown on your social security card, and
your new last name.
If you are a sole proprietor, you must furnish your
individual name and your SSN. You may also
enter your business name or doing business as”
name on the business name line. The SSN will be
used for your vendor record with Stephen F.
Austin State University (SFASU). If you prefer the
use of your EIN for any required tax reporting,
enter that number also. Enter your name(s) as
shown on your social security card and/or as it
was used to apply for your EIN on Form SS-4.
What Name and Number to Give the Requestor
Type of Payee
Name to Use
SSN/EID
1. Individual
Individual
SSN or ITIN
2. Sole
Proprietor
Owner
SSN or both
3. Partnership
Partnership
EIN
4. Corporation
Corporation
EIN
5. Other Entity
Organization
EIN
Nonresident Alien Individual
For income tax purposes, nonresident alien
individual” means an individual who is neither a
U.S. citizen nor resident. Generally, an alien is
considered to be a U.S. resident if: The individual
was a lawful permanent resident of the United
States at any time during the calendar year, that
is, the alien held an immigrant visa (a “green
card”), or the individual was physically present in
the United States on: (1) at least 31 days during
the calendar year and, (2) 183 days or more during
the current year and the 2 preceding calendar
years (counting all the days of physical presence in
the current year, one-third the number of days of
presence in the first preceding year, and only one-
sixth of the number of days in the second
preceding year.)
See IRS Pub. 519, U.S. Tax Guide for Aliens, for
more information on resident and nonresident
alien status.
VISA Status Immigration regulations regarding
work eligibility of non-immigrants are complex.
Contact Accounts Payable at SFA via email
accountspayable@sfasu.edu for preliminary
information regarding visa types that permit
payment for services.
Withholding Foreign persons are not generally
required to have a U.S. TIN, nor are they subject to
any backup withholding because they do not
furnish a TIN to a payer. However, non-employee
payments to nonresident aliens are subject to
30% tax withholding unless a tax treaty with their
country entitles them to either a lower rate or
exemption. To claim any available treaty benefits,
exemptions or current year tax residency statues;
the recipient must have a U.S. tax number (SSN or
ITIN) and contact accountspayable@sfasu.edu for
tax determination.
Backup Withholding - What is Backup
Withholding? Persons making certain payments
to you after January 1, 2006 are required to
withhold and pay to the IRS 28% of such payments
under certain conditions. This is called a “backup
withholding”. Payments that could be subject to
backup withholding include rents, royalties, non-
employee compensation, and payments for legal
or medical and health care services. Reportable
payments you receive will be subject to backup
withholding if: You do not furnish your TIN to the
requestor, or the IRS notifies the requestor that
you furnished an incorrect TIN.
Limited Liability Company (LLC) Entity Types
Generally, a multiple owner Limited Liability
Company is treated as a Partnership for tax
purposes. A Sole Owner LLC is considered a
Disregarded Entity and is reported under the sole
owner’s entity type. An LLC may elect to file as a
Corporation by filing IRS form 8832 directly with
the IRS. For more information see
https://www.irs.gov/Businesses/small-Businesses-
&-Self-Employed/Limited-Liability-Company-LLC
Payees and Payments Exempt from Backup
Withholding Certain payees and payments are
exempt from backup withholding and information
reporting. The following is a list of payees exempt
from backup withholding and for which no
information reporting is required. Payments
subject to reporting under Internal Revenue Code
(IRC) sections 6041 and 6041A are generally
exempt from backup withholding only if made to
payees described in items (1) through (7), except a
corporation that provides medical and health care
services or bills and collects payments for such
services is not exempt from backup withholding or
information reporting.
(1) A corporation. (2) An organization exempt
from tax under section 501(a), or an IRA, or a
custodial account under section 403(b)(7). (3) The
United States or any of its agencies or
instrumentalities. (4) A state, the District of
Columbia, a possession of the United States, or
any of their political subdivisions or
instrumentalities. (5) A foreign government or
any of its political subdivisions, agencies, or
instrumentalities. (6) An international
organization or any of its agencies or
instrumentalities. (7) A foreign central bank issue.
Claiming exemption If you are exempt from
backup withholding and/or FATCA reporting, enter
in the appropriate space on line 5 any code(s) that
may apply to you. Also see IRS instructions pg. 3.
https://www.irs.gov/pub/irs-pdf/fw9.pdf.
Privacy Act Notice
IRC section 6109 requires you to furnish your
correct TIN to persons who must file information
returns with the IRS to report certain payments.
The IRS uses the numbers for identification
purposes and to help verify the accuracy of your
tax return. You must provide your TIN whether or
not you are required to file a tax return. Payers
must generally withhold 28% of certain taxable
payments to a payee who does not furnish a TIN
to a payer. Certain penalties may also apply.
Penalties Failure to Furnish TIN If you fail to
furnish your correct TIN to a requestor, you are
subject to a penalty of $100 for each such failure
unless your failure is due to reasonable cause and
not willful neglect.
Civil Penalty for False Information with Respect
to Withholding If you make a false statement
with no reasonable basis that results in no backup
withholding, you are subject to a $500 penalty.
Criminal Penalty for Falsifying Information
Willfully falsifying certifications or affirmations
may subject you to criminal penalties including
fines and/or imprisonment.
Misuse of TINs If the requestor discloses or uses
TINs in violation of Federal law, the requestor may
be subject to civil and criminal penalties.
Historically Underutilized Businesses (HUB) The
State of Texas is encouraging state agencies to
utilize these businesses. You or your firm qualifies
if 51% owned by a person or persons who have
been historically underutilized because of their
identification as a member of certain groups:
Black Americans, Hispanic Americans, Asian-Pacific
Americans, Native Americans, or Women-any
ethnicity. To obtain a certification form, contact
S.F.A. HUB Coordinator at 936-468-4529.
With few exceptions, under TEX.GOV’T CODE
ANN. Sec. 559.003 (1) (2) & (3) (Vernon Supp.
1992), you are entitled to request to be informed
about the information the university collects,
under Sections 552.021 and 552.023 of the
Government Code, you are entitled to receive and
review the information, and under Section
559.004 of the Government Code, you are entitled
to have the university correct information about
you that is incorrect.