[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-302100-105":53,"doc-detail-302100-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","provider-tax-identification-reporting-form-substitute-irs-form-w-9","Provider Tax Identification Reporting Form - Substitute IRS Form W-9","","This document is the Provider Tax Identification Reporting Form, which serves as a substitute for the Internal Revenue Service (IRS) Form W-9 for the West Virginia Department of Human Services. It is designed to collect essential tax information from individuals and business entities to ensure compliance with federal tax regulations. The form requests specific identifiers such as Federal Employer Identification Numbers (FEIN) or Social Security Numbers (SSN), business or home addresses, and contact details. Additionally, filers must select their appropriate business entity type—ranging from sole proprietorships and LLCs to various corporate structures—to categorize their tax status accurately. The document underscores the necessity of these details for processing payments, explicitly stating that failure to provide a valid Taxpayer Identification Number (TIN) will result in a cessation of payments. The form requires a formal declaration of accuracy under penalty of perjury, accompanied by a handwritten signature to maintain legal validity. Completed forms are directed to be submitted to a designated caseworker or a county DoHS office, with a clear warning that incomplete submissions will be returned unprocessed, emphasizing the critical nature of thorough and precise information entry.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/provider-tax-identification-reporting-form-substitute-irs-form-w-9/302100/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/provider-tax-identification-reporting-form-substitute-irs-form-w-9/302100.png","ImageObject",442,249,{"name":88,"@type":89},"Stanley","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Why must providers furnish their Taxpayer Identification Number?","Question",{"text":108,"@type":109},"Providers must furnish their taxpayer identification number to the State pursuant to Internal Revenue Service regulations to ensure they remain eligible to receive payments.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What happens if I submit an incomplete form?",{"text":113,"@type":109},"Incomplete forms will be returned unprocessed, which may delay your status or payment processing.",{"name":115,"@type":106,"acceptedAnswer":116},"Are electronic signatures accepted on this form?",{"text":117,"@type":109},"No, only original handwritten signatures are accepted; electronic signatures will not be accepted.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},302100,1790317880,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},2336477405376,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Provider Tax Identification Reporting Form  \n(Substitute IRS Form W-9)  \nIF YOU ARE FILING THIS FORM AS A BUSINESS, COMPLETE THIS SECTION:  \nLegal Name:   Doing Business As (DBA) Name:  Federal Employer Identification Number:    \nIF YOU ARE FILING THIS FORM AS AN INDIVIDUAL, COMPLETE THIS SECTION:  \nIndividual Name:        \nLast Name First Name MI  \nSocial Security Number:    \nBusiness or Home Address:    \nStreet Address City/State Zip  \nMailing Address:   \nStreet Address City/State Zip  \nTelephone:    \nPursuant to Internal Revenue Service regulations, providers must furnish their taxpayer identification number (TIN) to the State. If this number is not provided, you will not receive payments.  \nCheck the type of entity that applies to your account:  \nIndividual/Sole Proprietor or Single-Member LLCC Corporation  \nS Corporation  \nPartnership  \nTrust/Estate  \nLimited Liability Company C Corporation S Corporation Partnership  \nOther  \nUnder penalty of perjury, Ideclare thatI have examined this request and to the best of my knowledge and belief it is true, correct, and complete.  \nPrint Name Date  \nSignature (original signature only, electronic signatures will not be accepted)  \nRETURN COMPLETED FORM TO YOUR CASE WORKER OR TO THE COUNTY DoHS OFFICE.  \nINCOMPLETE FORMS WILL BE RETURNED UNPROCESSED.","cbCaijXDsgihzRS1","https://ap.wps.com/l/cbCaijXDsgihzRS1","pdf",69446,"English","# Business Entity Section\n## Individual Filer Section\n# Taxpayer Identification Requirements\n## Entity Type Classification\n# Declaration and Signature","[{\"question\":\"Why must providers furnish their Taxpayer Identification Number?\",\"answer\":\"Providers must furnish their taxpayer identification number to the State pursuant to Internal Revenue Service regulations to ensure they remain eligible to receive payments.\"},{\"question\":\"What happens if I submit an incomplete form?\",\"answer\":\"Incomplete forms will be returned unprocessed, which may delay your status or payment processing.\"},{\"question\":\"Are electronic signatures accepted on this form?\",\"answer\":\"No, only original handwritten signatures are accepted; electronic signatures will not be accepted.\"}]","Provider Tax Identification Reporting Form - Substitute IRS Form W-9 | PDF",1789789031]