NEW YORK STATE OFFICE OF THE STATE COMPTROLLER SUBSTITUTE FORM W-9 - REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION

Sep 19, 2026

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New York State Office of the State Comptroller Substitute Form W-9 collects vendor payee information needed to report income and to certify the correct Taxpayer Identification Number (TIN). The form guides completion of legal business name, DBA, entity type, TIN and identification type, physical and remittance addresses, and exemption from backup withholding where applicable. It also requires signature, date, preparer contact details, and an authorized individual’s contact information, with submission instructions for FAX, email, or mail. The document also explains why the information is required under U.S. Internal Revenue laws and how backup withholding is avoided.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Part I: Vendor Information

Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type

Part III: Address

Part IV: Exemption from Backup Withholding and Certification

Part V: Contact Information – Individual Authorized to Represent the Vendor

Instructions for Completing Substitute W-9

AC 3237 (12/09) | | | | NEW YORK STATE OFFICE OF THE STATE COMPTROLLER SUBSTITUTE FORM W-9:
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION | | | | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION. | | | | | | | | | | | | | | | | | | Part I: Vendor Information | | | | | | | | | | | | | | | | | | 1. Legal Business Name: | | | | | | | | | | 2. If you use a DBA, please list below: | | | | | | | | 3. Entity Type (Check one only):
Sole Proprietor Partnership Limited Liability Co. Business Corporation Unincorporated Association/Business | | | | | | | | | | | | | | | | Federal Government | | | State Government | | | Public Authority | | Local Government | | School District | | | | Fire District | | Other | | | | Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type | | | | | | | | | | | | | | | | | | 1. Enter your TIN here: (DO NOT USE DASHES)
2. Taxpayer Identification Type (check appropriate box):

Employer ID No. (EIN) Social Security No. (SSN) Individual Taxpayer ID No. (ITIN) N/A (Non-United States Business Entity) | | | | | | | | | | | | | | | | | | Part III: Address | | | | | | | | | | | | | | | | | | 1. Physical Address: | | | | | | | | | 2. Remittance Address: | | | | | | | | | Number, Street, and Apartment or Suite Number | | | | | | | | | Number, Street, and Apartment or Suite Number | | | | | | | | | City, State, and Nine Digit Zip Code or Country | | | | | | | | | City, State, and Nine Digit Zip Code or Country | | | | | | | | | Part IV: Exemption from Backup Withholding and Certification | | | | | | | | | | | | | | | | | | For payees exempt from Backup Withholding, check the box below. Valid explanation required for exemption. See instructions.
Exempt from Backup Withholding
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number (TIN) .
Sign Here:
Signature Date
Print Preparer's Name Phone Number Email Address | | | | | | | | | | | | | | | | | | Part V: Contact Information – Individual Authorized to Represent the Vendor | | | | | | | | | | | | | | | | | | Vendor Contact Person: Title:
Contact’s Email Address: Phone Number: | | | | | | | | | | | | | | | | | | DO NOT SUBMIT FORM TO IRS-SUBMIT FORM TO NYS ONLY AS DIRECTED
By FAX (518) 473-4392, Email [VMU@osc.state.ny.us](VMU@osc.state.ny.us) or mail to:
110 State Street Mail Drop 10-4 Albany, NY 12236-0001 | | | | | | | | | | | | | | | | | | FOR OSC USE ONLY | | | | | | | | | | | | | | | | | NYS Office of the State Comptroller Instructions for Completing Substitute W-9 New York State (NYS) must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you or your organization. NYS Office of the State Comptroller uses the Substitute Form W-9 to obtain certification of your TIN in order to ensure accuracy of information contained in its payee/vendor database and to avoid backup withholding.1 We ask for the information on the Substitute Form W-9 to carry out the Internal Revenue laws of the United States. You are required to give us the information. Any payee/vendor who wishes to do business with New York State must complete the Substitute Form W-9 . Substitute Form W-9 is the only acceptable documentation. We will not accept IRS Form W-9 . Part I: Vendor Information 1. Legal Business Name: For individuals,

FAQs

What information must be provided in Part I (Vendor Information)?

Provide the legal business name, any DBA name, and the entity type that does business with New York State. Names should not be abbreviated.

Which TIN types can be entered on the form, and how do you choose the identification type?

Enter the TIN (nine-digit Social Security Number, ITIN, or Employer Identification Number). Then check the box matching the identification number type provided, such as EIN, SSN, ITIN, or N/A for a non-United States business entity.

When is backup withholding relevant, and how can it be exempted?

Reportable payments made by New York State are generally subject to backup withholding. Backup withholding exemption applies to government and non-United States business entities; you must sign, date, and provide the required certification and preparer details to support the exemption.

Sep 19, 2026

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