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DCL-99-110
Date: OCT 6, 1999
TO: ALL STATE IV-D DIRECTORS
RE: Financial Institution Data Match Fact Sheets
Dear Colleague:
Attached, for State use, are fact sheets and tip sheets related to financial institution data match (FIDM). Some were issued previously and reappear here as updates. The attachments cover the uses of match information, preparation for FIDM operations, outreach to financial institutions, privacy and security, and questions frequently asked.
Thanks to the many State child support agencies that contributed to these materials. We would appreciate receiving copies of other FIDM related materials as your office develops them. Please contact L. Gina Barbaro, Financial Industry Liaison, at (202) 401-5426, should you have materials or suggestions for our office to provide technical assistance on the data match.
Sincerely,
David Gray Ross
Commissioner
Office of Child Support Enforcement
Attachments:
FIDM Overview
Uses of FIDM Match Information
State Preparation for FIDM
Tips for Identifying Financial Institutions
Fees and FFP
Outreach Tips
Mail Stuffer Fact Sheet
FIDM Waiver
FIDM Privacy and Security
Frequently Asked Questions
FIDM Resources
Generic Agreement
cc: ACF Hub Directors and Regional Administrators
CSE Regional Program Managers
Financial Institution Data Match
Overview
September 27, 1999
America's children need and deserve financial and emotional support from both parents. Nationally, the number of child support cases has increased from 2 million in 1976 to 20 million cases in 1997. Despite the wide range of enforcement remedies, nearly one half of all child support cases receive minimal or no support. The Federal Office of Child Support Enforcement (OCSE), working together with State and local child support programs, is committed to improving the lives of children by implementing a nationwide child support enforcement strategy. A new tool in this strategy is the Financial Institution Data Match (FIDM).
Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), also known as the Welfare Reform Act, was signed into law on August 22, 1996. Its primary goal is to move families off public assistance by helping them become self-sufficient. To achieve this goal, both parents must assume financial responsibility for their children. To this end, PRWORA provides a much strengthened child support enforcement program for all families.
One provision of PRWORA requires all States to enter into agreements with Financial Institutions conducting business within their State for the purpose of conducting a quarterly data match. This data match is intended to identify accounts belonging to parents who are delinquent in their child support obligation. When a match is identified, State child support programs may issue liens or levies on the accounts of that delinquent obligor to collect the past-due child support.
What are the goals of the FIDM?
Who decided how FIDM should work?
What legislation established the FIDM program?
What Financial Institutions must participate in the data match program?
What types of accounts are subject to the data match program?
How often must the data match be conducted?
What data is returned to the child support program for use in collecting delinquent child support obligations?
Where can I get a copy of the data specifications?
Financial Institution Data Match
Single-State Financial Institutions
Every State is required by law to enter into agreements with Financial Institutions doing business within their State to develop and perform a quarterly data match for the purpose of collecting delinquent child support obligations. Financial Institutions will fall into one of two categories: single-state or multistate. A single-state Financial Institution is one which conducts business solely within one State. These institutions are generally smaller, independent banks, credit unions, and savings and loans which operate within a single- state. Multistate Financial Institutions, on the other hand, operate in two or more States.
What types of agreements are necessary?
Must States pay a fee to Financial Institutions for conducting the data match?
What is the methodology of performing the data match?
How does Method One, the all accounts method, work?
How does the Matched Accounts Method Work?
Can a single-state Financial Institution be held liable for the release of account information relating to the FIDM program and the levies that may result?
How can I obtain additional information?
Financial Institution Data Match
Multistate Financial Institutions
With the recent trend in mergers more Financial Institutions are operating in multiple States. The Financial Institution Work Group members noted that the task of matching files submitted by many States appeared to be arduous, time consuming and costly to those Financial Institutions operating in two or more States. To alleviate these concerns and facilitate timely data matches, Public Law 105-200 added provisions to Title IV-D of the Social Security Act which allows the Federal Office of Child Support Enforcement (OCSE), through the Federal Parent Locator Service (FPLS), to assist States in conducting data matches with Multistate Financial Institutions (MSFI).
What are the goals of the Multistate Financial Institution Data Match?
How will Multistate Financial Institutions be notified?
What is included in the single OCSE/MSFI Operational Agreement?
How are fees handled in the Multistate Financial Institution Data Match?
Do States and MSFIs have the option of participating in the Multistate FIDM program?
How will the Multistate Financial Institution Data Match be conducted?
Can Financial Institutions be held liable for the release of account information relating to the FIDM program?
When will the Multistate Financial Institution Data Match begin?
How can I obtain additional information?
USES OF FIDM MATCH INFORMATION
September 27, 1999
Freeze and Seize Funds from Financial Accounts
The State child support agency establishes procedures to identify cases that meet arrearage threshold and other program screening criteria subjecting them to the data match with financial institutions and to any subsequent freeze and seize action. Financial institutions are required to encumber or surrender the assets of the delinquent obligor held by the institution in response to the freeze and seize notice from the state agency. The freeze and seize is subject to the laws of the state where the asset is located and to the due process provisions, account balance thresholds and exemption thresholds of those laws.
Locate Obligors
Most account applications request residence, employer, date of birth, social security number and other information that can be used to locate the obligor or to establish leads for locate purposes. If the financial institution is unwilling to furnish a copy of the application, the State can request a blank application then request specific information to open the account. The State child support office may use administrative subpoena power to obtain a copy of the application the non-custodial parent completed to open an account.
Establish or Modify Support Orders
Information about an obligor's financial situation assists the State in negotiating a fair and equitable support amount. More complete financial information is particularly helpful in cases where the obligor is self-employed or where there is no income verification.
Enforce a Payment Agreement
Knowing the account balance and how much is deposited in the account on a regular basis makes it easier for the State to identify how much is available for a payment agreement. In addition, the current balance and history of the account gives leverage to the enforcement agent to persuade the non-custodial parent to pay up or to make the obligor aware that the information could be shared with the Judge in court to prove the obligor has the ability to pay. In contempt proceedings against an obligor, the State can present evidence of an asset to assist the court in determining the proper amount of payment necessary to remove the contempt.
STATE PREPARATION FOR FIDM
September 27, 1999
Establish Freeze and Seize Policy and Procedures
Action Steps: Identify policy and procedures based on state laws governing freeze and seize of financial institution accounts (e.g., freeze period, dollar thresholds.) If process is judicial, issue legislation to move to administrative procedures. Issue legislation to authorize the data match.
Resources:
Develop Handbook of Instructions and Enrollment Forms, Identify FIs, Conduct Outreach
Action Steps: Develop a handbook of instructions advising institutions of reporting requirements and data specifications. Develop an agreement discussing responsibilities, timelines and fees, and an election form identifying available matching and data transmission methods. Identify financial institutions doing business within the state. Educate financial institutions through outreach efforts.
Resources:
Automate What is Appropriate
Action Steps: Develop forms, notices, letters and reports. Automate data specifications, generation of forms and letters, financial institution database, compliance tracking, program reporting and management reports.
Resources:
Provide for Customer Service and Public Relations
Action Steps: Establish a hotline, e-mail address and website to answer financial institution questions, and a direct line to answer questions from non-custodial parents. Build a working relationship with the state trade associations and operations staff of the financial institutions.
Staff and Train
Action Steps: Determine volume of workload and establish a review and appeal unit, customer relations and customer service units as needed. Train workers.
Federal Office of Child Support Enforcement (OCSE)
Financial Institution Data Match (FIDM)
"Tips" Sheet
September 27, 1999
TIPS FOR IDENTIFYING FINANCIAL INSTITUTIONS IN YOUR STATE
September 27, 1999
Resources
DCL-98-120, dated November 16, 1998 - multi-state institutions
DCL-99-11, dated February 12, 1999 - single-state institutions
Entities
Agencies and associations that can assist with identifying financial institutions, providing mailing lists/labels, conducting outreach, selecting pilot sites and development of policy and procedures:
Websites
Access the Federal Deposit Insurance Corporation website at www.fdic.gov to identify banks, savings and loans, and thrifts.
Note: To update your list of FDIC institutions, select "Established Date" from the "Sort By" drop-down box, for institutions insured since the date of your last listing.
Access the National Credit Union Administration website to identify credit unions at www.ncua.gov.
Deleting the DCL-98-120 names of multi-state institutions, from the website list of all institutions operating within your state, will result in a list of single-state institutions only. OCSE has provided an electronic copy of the list to each state FIDM liaison to make this deletion of multistate institutions easier.
FEES AND FFP
FINANCIAL INSTITUTION DATA MATCH
September 27, 1999
Resources
DCL-99-35, dated April 5, 1999
Policy
In accordance with Section 466(a)(17)(B) of the Social Security Act, the State child support agency may pay a reasonable fee to institutions conducting the financial institution data match, not to exceed the actual costs incurred by the institution.
Federal financial participation (FFP) is available at a rate of 66% of administrative expenditures for operational costs, including the cost of paying matching fees to financial institutions. FFP at a rate of 66% is available for state developmental costs. FFP is not available for development costs of financial institutions because there is no authority under the Act to pay for such expenditures.
State Experience
Some States have written into their legislation the option to reimburse financial institutions for conducting this data match with accounts of delinquent obligors. The amounts range from $150 to $250 per institution for each quarterly matching process. Generally, these figures are based on questioning a small number of financial institutions. In one case the $250 fee limit was based on what some service providers charge for all regulatory processing. States conducting pilots, such as Washington, found that many institutions performed the match for much less than the limit or for free. North Carolina has been successful in having its institutions perform the match at no cost. Since the fees established thus far may not be a valid indicator of reasonable fees for every type institution in every State, it will be very important for States to rely on billing documentation to determine reimbursement amounts based on actual costs.
Negotiating Fees
Since there is no universal fee limit that can be applied across the board, the following are factors States might consider and discuss when negotiating reimbursement fees with financial institutions:
Billing Documentation
Attached is a worksheet that suggests some cost areas states may ask financial institutions to document on their invoice.
FINANCIAL INSTITUTION - SUMMARY OF COSTS
FOR CHILD SUPPORT DATA MATCH
September 27, 1999
START UP COSTS
a. Labor time to create program ____________ (hr, min, sec)
b. Hourly labor rate $___________
c. Labor cost to create program (a*b) $___________
d. CPU time to create program ____________/(hr, min, sec)
e. CPU cost rate $___________/(hr, min, sec)
f. CPU cost to create program (d*e) $___________
Total Start-Up Costs (c+f) $___________
QUARTERLY MATCHING COSTS
g. Labor time to process match/extract ____________ (hr, min, sec)
h. Hourly labor rate $___________
i. Labor cost to process match/extract (g*h) $___________
j. CPU time to process match/extract ____________/(hr, min, sec)
k. CPU cost rate $___________/(hr, min, sec)
l. CPU cost to process match/extract (j*k) $___________
m. Postage, mailing, supplies cost $___________
Total Quarterly Match/Extract Costs (i+ l+m) $___________
OUTREACH TIPS
FINANCIAL INSTITUTION DATA MATCH
September 27, 1999
Resources
DCL-99-45, dated April 26, 1999 - Outreach Materials for FIDM
DCL-99-34, dated April 5, 1999 - California FIDM Handbook
DCL-99-15, dated February 17, 1999 - Generic Agreement for In-state FIDM
DCL-98-120, dated November 16, 1997 - Certification Addendum for Multi-state FIDM
OCSE developed a brochure, video, PowerPoint presentation and script that are available by writing J&E Associates, 1100 Wayne Avenue, Suite 820, Silver Spring, MD 20910 or phoning Mironda Thomas at 301-587-4220 x254.
Strategies
Attachments
Dear Colleague Letter (DCL-98-120, dated November 16, 1998), describes the process for entering into agreements with multi-state institutions to conduct the financial industry data match through the Federal Parent Locator Service (FPLS). Attached are two generic agreements and transmittal sheet which States may adapt to their legal requirements, procedures and automated systems for entering into agreements with in-state financial institutions and multi-state financial institutions not opting to use the FPLS.
The first, more formal agreement, is intended for situations where there is cost reimbursement. The second, more streamlined agreement, is better suited for a no cost reimbursement situation where the financial institution is merely agreeing to begin reporting. The generic agreements and transmittal were developed by incorporating ideas and language from existing agreements for several States. They are not intended to be standardized agreements. Rather they may be used as models for adaptation to a State's particular requirements and environment.
MAIL STUFFER FACT SHEET
Financial Institution Data Match
September 27, 1999
Public Law 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), requires States to establish procedures under which the State child support enforcement (IV-D) agency to enter into agreements with financial institutions doing business in the State for the purpose of securing information leading to the enforcement of child support orders. The State shall develop and operate, in coordination with these financial institutions, a data match system in which each financial institution will provide quarterly the name, record address, social security number or other taxpayer identification number for each noncustodial parent who maintains an account at such institution and who owes past-due support. The State must supply the name and social security number or other taxpayer identification numbers. These procedures must provide for automated data exchanges to the maximum extent feasible.
Financial institutions that must participate in the match include banks, credit unions, savings and loans, benefit associations, insurance companies, safe deposit companies, money-market mutual funds, and similar institutions. Accounts subject to the data match include demand deposit accounts, checking accounts or negotiable withdrawal order accounts, savings accounts, time deposit accounts, and money-market mutual fund accounts.
The data matches are done by either of the following two methods using data specifications approved by the U.S. Office of Management and Budget (OMB Control No: 0970-0196) on March 5, 1999. Under Method 1 (all accounts method), the financial institution submits a file containing all open accounts which is matched against records of delinquent obligors. Under Method 2 (matched accounts method), the financial institution receives a file of delinquent obligor records, matches the file against open accounts, and submits a file of matched records.
Section 466(a)(17)(B) of the Act establishes that the State child support agency may pay a reasonable fee to institutions conducting the data match, not to exceed the actual costs incurred by the institution. Some States have written into their legislation the option to reimburse financial institutions for conducting the data match.
Pursuant to Section 466(a)(17)(C) of the Act, a financial institution will not be liable under any Federal or State law to any person for: (1) any disclosure of data match information to the State IV-D agency, (2) encumbering or surrendering any assets held by a financial institution in response to a notice of lien or levy issued by the State IV-D agency, or (3) any other action taken in good faith to comply with the requirements of Section 466(a)(17) of the Act.
Public Law 105-200, the Child Support Performance and Incentive Act of 1998, modified PRWORA to allow the Federal Office of Child Support Enforcement (OCSE) to use the Federal Parent Locator Service (FPLS) to facilitate the data match for multistate financial institutions (MSFI) (i.e., those operating within two or more States). Public Law 105-200 authorizes OCSE to act as the conduit between the States and territories and the MSFIs in the development and implementation of a centralized, quarterly data match program. Multistate financial institutions may opt to match through the OCSE or with the individual states in which they do business.
FIDM WAIVER
September 27, 1999
Background
If a State recognizes that the quarterly data match may place an initial burden on certain financial institutions, it may choose to grant a waiver from the data match requirements.
Criteria
A State sets it's own waiver criteria. Examples of conditions selected by some States include:
Waiver Request Form
Generally, States require the institution to complete a waiver request form includes identifying information about the financial institution, the reason for the waiver, the length of period for which the waiver is requested and an official signature.
Institution Information:
Name: FEIN:
Contact: Phone:
Street Address: Mailing Address (if different from street address):
Criteria:
a) Number of active accounts? __________
b) Accounts on a computerized record keeping system: ______ yes ______ no
If no, when do you plan to implement computerized record keeping? Date ___________
c) Facing complex systems changes? ______ yes ______ no
If yes, please explain: ______________________________________________________
If no, when do you plan to implement the required data match changes? Date ___________
Action:
Calendar year quarters for which requesting a waiver:
_____ quarter 1 _____ quarter 2 _____ quarter 3 _____ quarter 4
FIDM PRIVACY AND SECURITY
September 27, 1999
Federal law requires that a State child support enforcement agency which obtains a financial record of an individual from a financial institution pursuant to the data match system described in subsection 466 (a) (17) of the Act may disclose such financial record only for the purpose of, and to the extent necessary in, establishing, modifying or enforcing a child support obligation of such individual. The civil damages, through civil action in a United States district court, described in subsection 469A (c) of the Act apply to any unauthorized disclosure.
Pursuant to Section 466(a)(17)(C) of the Act, a financial institution will not be liable under any Federal or State law to any person for: (1) any disclosure of data match information to the State IV-D agency, (2) encumbering or surrendering any assets held by a financial institution in response to a notice of lien or levy issued by the State IV-D agency, or (3) any other action taken in good faith to comply with the requirements of Section 466(a)(17) of the Act.
States must comply with the requirements of title IV-D of the Act pertaining to the safeguarding of data, including those provisions that specifically apply to the operation of the financial institution data match system. States must have appropriate administrative, technical, and physical safeguards to ensure the security and confidentiality of both IV-D data and financial records, as well as any data matches resulting from comparisons of these records.
States must establish measures to ensure that 1) data obtained for the purpose of operating the financial institution data match system is 1) used for no other purpose; 2) disclosed to and used by only those individuals who require the use of such data in the performance of their official duties; and 3) retained only so long as necessary for the effective operation of such system and thereafter disposed in a manner that preserves its confidentiality.
Measures States can take to ensure the safeguarding of data include:
QUESTIONS FREQUENTLY ASKED BY FINANCIAL INSTITUTIONS
September 27, 1999
Q. What type of accounts are included in the match process?
A. Each State needs to develop its own answer.
Q. How should a financial institution handle a notice of full or partial release of the freeze or seize?
A. Each State needs to develop its own answer.
Q. If the financial institution receives a notice of extension, how long should the hold on the account be extended?
A. Each State needs to develop its own answer.
Q. What if the obligor/account holder wants to know how to find out more information on the freeze of his/her account, whom should they call?
A. Each State needs to develop its own answer.
Q. If the financial institution's levy/garnishment staff is processing a FIDM document and has a question, should they call the same phone number.
A. Each State needs to develop its own answer.
FINANCIAL INSTITUTION DATA MATCH RESOURCES
September 27, 1999
Website
OCSE Home Page/NECSRS: http://www.acf.hhs.gov/programs/cse
Outreach Products
FIDM brochure, video, PowerPoint presentation and script available by writing J&E Associates, 1100 Wayne Avenue, Suite 820, Silver Spring, MD 20910
OCSE Issuances
DCL-99-90, dated September 1, 1999, Multistate Financial Institution Data Match, First Edition of MSFIs Electing OCSE Match
DCL-99-89, dated September 1, 1999, Freeze and Seize Matrix
PIQ-99-06, dated August 16, 1999, Direct Imposition of Liens and Levies Across State Lines
DCL-99-71, dated July 9, 1999, MSFIDM/AEI Pilot
DCL-99-69, dated July 1, 1999, Multistate Financial Institution Data Match, First Edition of MSFIs Electing OCSE Match
DCL-99-51, dated May 8, 1999, FCR Interface Guidance Document Update 6
DCL-99-46, dated April 30, 1999, Massachusetts Forms, Letters and Reports for Financial Institution Data Match
DCL-99-45, dated April 26, 1999, Outreach Materials for Financial Institution Data Match
DCL-99-44, dated April 26, 1999, Arizona Pilot and Procedures for Financial Institution Data Match and Account Seizure
DCL-99-35, dated April 5, 1999, Negotiating Processing Fees for Financial Institution Data Match
DCL-99-34, dated April 5, 1999, California Financial Institution Data Match
DCL-99-15, dated February 17, 1999, Generic Agreement for Financial Institution Data Match
DCL-99-11, dated February 12, 1999, Identifying Single State Financial Institutions
DCL-99-04, dated January 6, 1999, Georgia's Implementation Process for Financial Institution Data Match
DCL-98-130, dated December 21, 1998, Financial Industry Liaison Officer
DCL-98-120, dated November 16, 1998, Multistate Financial Institution Data Match, Certification Addendum
AT-98-29, dated October 15, 1998, Response to Questions on Financial Institution Data Match
AT-98-07, dated March 2, 1998, Policy Questions and Answers Regarding the Financial Institution Data Match Requirements
AT-98-05, dated March 2, 1998, Implementing High Volume, Automated Administrative Enforcement of Interstate Cases
DCL-97-93, dated December 16, 1997, Results of the Financial Institution Work Group Meeting
AT-97-19, dated November 20, 1997, Distribution of Federally Approved Interstate Child Support Enforcement Forms: Administrative Subpoena and Notice of Lien
STATE TECHNICAL ASSISTANCE LIAISONS
The Federal Office of Child Support Enforcement’s (OCSE’s) State Technical Assistance (TA) team has assigned a liaison for each State. If you have any questions or concerns, we encourage you to contact your State TA liaison directly.
GENERIC AGREEMENT FOR
FINANCIAL INSTITUTION DATA MATCH
PURPOSE:
This Agreement establishes requirements to be met by the (insert applicable Department) and (insert applicable Financial Institution), pursuant to (insert applicable State statute) of State law and section 466(a)(17) of the Social Security Act, for the purpose of developing and operating a data match system. The Financial Institution shall participate in the automated exchange of data by providing on a quarterly basis, identifying information for each noncustodial parent who maintains an account at such institution and who owes past-due support, as identified by the Department. The automated, data exchange system will be implemented and managed through the child support enforcement program of the Department and/or its authorized agent. The Department and Financial Institution hereby agree as follows:
ACTION:
To participate, the Financial Institution must sign and return this Agreement (insert number) days prior to beginning of the quarter in which you plan to enter the program.
Enter Match Program Agreement Due Report Data For File Due By
1st quarter (begins Jan.1) (insert date) 4th quarter (insert date)
2nd quarter (begins Apr. 1) (insert date) 1st quarter (insert date)
3rd quarter (begins Jul.1) (insert date) 2nd quarter (insert date)
4th quarter (begins Oct. 1) (insert date) 3rd quarter (insert date)
PARTIES TO THE AGREEMENT:
State Department: (insert information)
Contact Person: (insert information)
Title: (insert information)
Address: (insert information)
Telephone Number: (insert information) Fax: (insert information)
E-mail: (insert information)
Financial Institution: ____________________________________________________________
Contact Person: ________________________________________________________________
Title: _________________________________________________________________________
Street Address: ________________________________________________________________
Mail Address (if different)________________________________________________________
Telephone Number: _____________________________ Fax: ___________________________
E-mail: _______________________________________________________________________
MATCH METHODOLOGY:
The Financial Institution may elect to transmit the required information to the Department by either of the following two methods. The method checked will be the method by which the financial institution agrees to participate.
The Financial Institution shall submit to the Department by (insert date), a file identifying all open accounts. The Financial Institution must submit a supplemental file within (insert timeframe) of the end of each subsequent calendar quarter. This supplemental file must identify each new account opened as well as each account closed in the prior quarter.
Institution shall modify the annual 1099 series information returns as instructed in the Bank Match Specifications Handbook, and consider accounts on that file to have been reported under the Bank Match System.
Institution shall match a file supplied by the Department not more than quarterly against all accounts maintained at that institution. Institution electing this option shall report information required by the Department on all accounts at the institution maintained by persons on the Department’s inquiry file. Institution shall submit a match file within (insert number) days of receiving an inquiry file from the Department.
DATA ELEMENTS AND REQUIREMENTS:
All data supplied under this Agreement as required below shall be in accordance with the Financial Data Match Specifications Handbook set forth in (insert exhibit name).
TRANSMISSION METHODOLOGY:
Please indicate the media for receiving and sending inquiry files from the state and for submitting accounts.
I will Receive file from state on:
I will Send accounts to state on:
AGENT:
The Financial Institution may designate an agent to perform the data match on its behalf by completing the information below.
Agent: _______________________________________________________________________
Contact Person: ________________________________________________________________
Title: _________________________________________________________________________
Street Address: ________________________________________________________________
Mailing Address (if different): ____________________________________________________
Telephone Number: _____________________________ Fax: ___________________________
E-mail: _______________________________________________________________________
COSTS AND FEES (OPTIONAL):
(Note: If State wants to include this section, it is best to base language on State law. The following serves merely as an example.)
The Department agrees to reimburse the Financial Institution for the costs of matching or producing data against all accounts maintained by the Financial Institution on a quarterly basis.
The Financial Institution shall be required to furnish the Department an account of expenditures/costs incurred in the performance of services. The Financial Institution shall submit within (insert number) days of the end of each calendar quarter, an itemized statement of services rendered for the prior quarter. Actual costs incurred in complying with this Agreement will be documented by the Financial Institution and submitted to the Department on a quarterly basis along with an itemized statement of services rendered. Upon receipt of a properly completed reimbursement claim, the Department shall authorize payment no later than (insert number) days after receipt of accurate and complete reports of the actual costs not to exceed the rate of reimbursement specified above. Claims shall be submitted to:
State Department: (insert information)
Contact Person: (insert information)
Title: (insert information)
Address: (insert information)
Telephone Number: (insert information)
Fax: (insert information)
E-mail: (insert information)
ADDITIONAL TERMS:
This Agreement will commence (insert date) and continue through (insert date), and shall continue thereafter year to year unless otherwise modified by the mutual agreement of both parties. This Agreement may be amended, waived or voided in writing at any time by mutual consent of both parties.
SIGNATURES:
Financial Institution ____________________________________________________
Title _________________________________________________________________
Date ______________________
Financial Institution Agent _______________________________________________
Title _________________________________________________________________
Date ______________________
Department ___________________________________________________________
Title _________________________________________________________________
Date ______________________
MAIL THE COMPLETED AGREEMENT FORM TO:
State Department: (insert information)
Contact Person: (insert information)
Title: (insert information)
Address: (insert information)
Telephone Number: (insert information)
Fax: (insert information)
E-mail: (insert information)
For assistance call the (insert unit name and phone number).
Data Match Agreement
Financial Institution Name Federal Identification Number
Address City, State, Zip
Contact Person Telephone Number
This agreement establishes requirements to be met by the insert state and Financial Institution, pursuant to insert applicable State statute of State law and section 466(a)(17) of the Social Security Act. This data exchange system will be implemented and managed through the child support enforcement program of the insert state and/or its authorized agent.
The above financial institution elects to transmit the required information to the insert state by one of the following methods:
[ ] Method 1 (All Accounts Method)
The Financial Institution shall submit quarterly to the Department by insert date, a file identifying all open accounts by the end of each month following the calendar quarter. Alternatively, the financial institution may submit a supplemental file in the 2nd, 3rd and 4th quarters identifying each new account opened as well as each account closed in the prior quarter.
[ ] Combined Method 1 and 1099 (All Accounts Combined with 1099 Reporting)
Institution shall modify the annual 1099 series information returns as instructed in the Data Match Specifications Handbook, and consider accounts on that file to have been reported under the Data Match System. Please refer to the Data Match Specifications Handbook for further filing information.
Magnetic Media to be used to report under Method One: [ ] insert media [ ] insert media [ ] insert media
[ ] Method 2 (Matched Accounts Method)
Institution shall match a file supplied by the Department not more than quarterly against all accounts maintained at that institutions. Institution shall report information required by insert state on all accounts at the institution maintained by persons on the insert state inquiry file.
Magnetic Media requested to receive State Inquiry File under Method 2: [ ] insert media [ ] insert media [ ] insert media
Magnetic Media to be used to report match information under Method 2: [ ] insert media [ ] insert media [ ] insert media
Electronic Data Transmission (EDT). Would your institution utilize EDT to receive and/or send Data Match information ?
[ ] Yes. Please check where applicable: Connect Direct ___ EDI ___ Internet WWW___ Other
[ ] No. Institution is capable of using EDT, but would not for Data Match purposes.
[ ] Institution does not utilize EDT.
Reporting Agent/Transmitter: If you are utilizing the services of a Reporting Agents or Transmitter to file Data Match information, identify below: Please inform insert state whenever your institution changes Reporting Agents.
Reporting Agent/Transmitter Name
Street Address _______________________________________________________________
City State __________ Zip
Contact Person Phone Ext.
Please sign, date and mail to (insert state address). You may fax this form to (xxx) xxx-xxxx.
Name Date
FINANCIAL INSTITUTION DATA MATCH
MAGNETIC MEDIA TRANSMITTAL
File Creation Date _______________ Number of Records _____________
Type of Reporting: ____ Method 1 ____ Method 1/1099 ____ Method 2
Financial Institution ______________________________________________________
Street Address ___________________________________________________________
Mailing Address (if different) _______________________________________________
City ____________________________________ State _________ Zip _____________
Contact Person ______________________________ Phone ______________ Ext. _____
If Transmitting Agency is different than above, please supply the following information:
Transmitting Agency ______________________________________________________
Street Address ___________________________________________________________
Mailing Address (if different) _______________________________________________
City _____________________________________ State ________ Zip _____________
Contact Person _____________________________ Phone _______________ Ext. _____
Media Characteristics:
Tapes/cartridges: ___ EBCDIC ___ ASCII Diskettes: ___3 ½ ___5 ¼
___ STD LBL ___ NO LBL Filename on diskette:
Compatibility: ___ 3480 ___ 3490 _______________________
Forward this form with your magnetic media file to:
Contact Person: (insert information)
State Department: (insert information)
Street Address: (insert information)
For assistance call the (insert unit name and phone number).
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FIDM
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State and Tribal
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State Profiles
Resources:
Grants Information
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Información en Español
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International
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Federal/State Topic Search (NECSRS)
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Tribal
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Virtual Trainer's Library