Contra Costa California Form Instructions W-9 2024-2025

Contra Costa California Form Instructions W-9: What You Should Know

The Provider number is  For billing services to be handled using the ARMS system, all W-9 applications must be submitted by the Provider (or its agent) and must include: 1) a completed Form W-9 † 3) an Employee Identification Number (EIN) and the employee's signature, if any, 4) a current employer identification number (EIN) and a company name and/or the address of each employer 5) a signed consent form that states the number on which the claim is being filed 6) the dates at issue for each claim 7) the employer's current address (unless the employer is outside of California) 8) the Employer Telephone Number 9) the Form W-9 fee Click here for additional information and form reference 9-2. Employer Telephone Number Employer Telephone Number — 100.00 For Employee Services (E-Services) to be fulfilled using the ARMS system, all E- Services must be filed and submitted by AR Support personnel. For each new E-Service, AR Support will obtain payment of the appropriate Claim Form (the fee for the Claim Form is determined by the Claim Form fee schedule).  For an Employee to receive Services under the EIS program, the employee must complete the appropriate Claim Form, sign the form, and enclose the signed form with their W9 form. An Employee will be able to download the appropriate Claim Form from a separate webpage on the ARMS website. For Payment Options, please click here If filing an employee with E-Service who has never submitted a claim to CCP or within the last 2 years, the Employee should refer to the CCP Policy on E-Services for instructions regarding when a company is required to file a claim with CCP. E-Services will NOT be processed if the form cannot be provided; in addition, unless a payment option is entered, the employee will not be billed for Services (if this is the case, check the “Submit a claim form if no payment option is selected” Box on the W9 and E-Services Request Form). Form W-9 Retention Letter: If you have more than 500 employees, you must send the W-9 Retention Letter to AR Support, Attn: W-9, c/o CC Human Resources.

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