Fillable Form 54-102 - Texas 9-1-1 Equalization Surcharge Report printable pdf download

54-102

PRINT FORM

RESET FORM

(Rev.1-12/5)

Texas 9-1-1 Equalization Surcharge Report

93100

a. T Code

Type or print.

Do not write in shaded areas.

c. Taxpayer number

d. Filing period

f. Due date

Blacken this box if your mailing address has

g. Name and mailing address (Make any necessary name or address changes below.)

changed. Show changes by preprinted information.

Blacken this box if you are no longer in business,

and enter the date you went out of business below.

Month

Day

Year

Instructions for Completing

Texas 9-1-1 Equalization Surcharge Report

WHO MUST FILE -

Service providers, as defined in Tex. Health & Safety Code Section

under Chapters 552 and

You have certain rights

559, Government Code, to review, request and correct

771.001(14), including wireless service providers and providers of Voice over Internet Protocol

information we have on file about you. Contact us at

(VoIP) voice communications, must file this report and remit the surcharge due each month.

the address or phone number listed on this form.

The surcharge is imposed on all local exchange access lines or equivalent local exchange access

lines as defined in 1 Tex. Admin. Code Section 255.4 (2007) (Commission on State Emergency

Communication, Definition of), and each wireless telecommunications connection as defined in

Tex. Health & Safety Code Section 771.001(13).

The surcharge may not be imposed on the access lines or wireless telecommunications

connections of the state or federal government, on a line to public telephone equipment, or on a

wireless telecommunications connection that constitutes prepaid wireless telecommunications

Electronic reporting and payment options

service subject to Tex. Health & Safety Code Section 771.0712.

are available 24 hours a day, 7 days a week.

Have this form available when you log on.

WHEN TO FILE -

The report must be filed on or before the 30th day following the end of the

month in which the surcharges are collected. If the due date falls on a Saturday, Sunday or legal

holiday, the next business day is the due date. The report must be filed each month, even if no

equalization surcharge is due.

Do not enter negative figures.

1. Total number of local exchange access lines or equivalent local exchange access lines

and wireless telecommunications connections

2. Gross equalization surcharge due

(Multiply Item 1 by $0.06)

3. Administrative fee retained

(Service providers may retain an administrative fee of 1% of the total 9-1-1 equalization surcharge collected.)

4. Net equalization surcharge due

(Subtract Item 3 from Item 2.)

54-102 (Rev.1-12/5)

5. Penalty due -

If this report is filed or the surcharge due is paid after the due date, enter penalty.

(If 1-30 days late, enter 5% of the amount in Item 4.

If more than 30 days late, enter 10% of the amount in Item 4.)

6. Interest due

(If any surcharge is unpaid 61 days after the due date, enter interest on the amount in Item 4.

Calculate interest at the rate published online at or call the

Comptroller's office at 1-877-447-2834 for the applicable interest rate.)

7. TOTAL AMOUNT DUE AND PAYABLE

(Sum of Items 4, 5 and 6.)

Taxpayer name

T Code

Taxpayer number

Period

I declare that the information in this document and any attachments is true and

correct to the best of my knowledge and belief.

Taxpayer or duly authorized agent

Mail to: COMPTROLLER OF PUBLIC ACCOUNTS

Make the amount in

Item 7 payable to:

P.O. Box 149356

Daytime phone

Date

STATE COMPTROLLER

Austin, TX 78714-9356

For assistance with any 9-1-1 equalization surcharge question,

1-800-252-5555

512-463-4600

call

111 A

Details are also available online at

Form 54-102 - Texas 9-1-1 Equalization Surcharge Report

Related Articles

Related forms

Related Categories