(i.e, Name of Parent Company, Company, Personal Name that is used when taxes are filed)
Does (Name of Business) own the Federal Tax Identification Number/Social Security Number?
If not, who owns the Federal Tax Identification Number/Social Security Number?
What is the Federal Tax Identification Number (FTIN) or Social Security Number (SSN)
(This number is 9 digits long)
Is that number an FTIN or a SSN?
If that number is an FTIN, is it a corporation or not?
If the business is a corporation, on the CREATE PROVIDER screen, mark Tax Exempt.
If the business is not a corporation, in the CREATE PROVIDER screen, mark FTIN Taxable.
If the business is a SSN, on the CREATE PROVIDER screen, mark SSN Taxable.
Is there a Doing Business As (DBA) name?
If yes, what is the name of the DBA?
What is the address where authorizations should be mailed? (Try to get the 4 digits at the end of the zip code)
What is the address where payments should be mailed? (Try to get the 4 digits at the end of the zip code)
What is the geographical address (actual physical address) of the business?
Please enter the following in the NOTES section of QUEST’s CREATE PROVIDER screen:
phone number of the provider (mandatory)
ABN of the provider (if you find the provider in Nebraska Information System (NIS) Any other information can be entered on the OVERVIEW TAB/COMMENTS & TERMS SCREEN of PROVIDERS or the OVERVIEW TAB/CONTACTS SCREEN of PROVIDERS after the Provider is set up.
State Office Staff will enter the phone number in the OVERVIEW TAB/CONTACTS SCREEN of PROVIDERS after the Provider is set up.
Effective Monday, June 20, 2005 State Accounting will require a W-9 form (see #13 below) to be submitted in advance of a provider being added to the NIS Address Book. In addition to the W-9, in some cases, State Accounting is asking that a Minority, Women, Disabled Owned Designation Form (MWD) (see #14 below) be completed due to the importance of 1099 reporting and certain Federal Government reporting requirements. Both of these forms are on VRIS/Administrative Forms.
If the provider is not in NIS, inform the provider that the State of Nebraska is requiring them to complete a W-9. Inform the provider that Vocational Rehabilitation cannot authorize or process payments to them until the W-9 is returned. The provider or the staff member must fax, e-mail or mail the W-9 to Cinda Wacker (email@example.com), Vocational Rehabilitation, 301 Centennial Mall South, PO Box 94987, Lincoln, NE 68509, fax 402-471-0788.
Send all providers a MWD for them to complete and submit if the provider finds it applicable to their business. The MWD is not required for an issuance of an ABN. The provider can fax or mail the MWD to DAS, Materiel Division, State Purchasing Bureau, 301 Centennial Mall South, Mall Level, PO Box 94847, Lincoln, NE 68509-4847, fax 402-471-2089.
If a provider is already set up in NIS, NIS may ask for our help in obtaining a new W-9 or ACH if a business changes their name, FTIN or address. NIS may also ask for our help if a business changes their bank for electronic fund transfer (EFT) which would require a new ACH form.