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Form 1125-A Vancouver Washington: What You Should Know

Provider List, it's your responsibility to ensure that all participants have the right documents listed below to complete the program. If documents are not listed here, you must contact the agency to make sure that all applicable participants are included. 1. The SPI 1125 form must be signed and dated before the program closes. 2. In your document, please list all participants that can be verified. 3. This program does not include a full review of the SPI 1125 system. Any providers may request a full review of the SPI 1125 system. The agency that receives this application and the SPI 1125 form will be considered as the final reviewer. All decisions are final. Agency name: SW, Washington Branch office(s): SW, Washington Date closed: 11/18/2016 What to expect from the document The documentation described below must be provided to ensure that the program is valid and is consistent with federal and state requirements for the receipt and use of the program proceeds. Applicants must also provide a copy of the applicable federal tax form. Additional forms, instructions, and references are available below. The program does not include full reviews of SPI or other tax system applications, so providers may still request full reviews. 1. To ensure that costs and taxes are paid when they are incurred, each participant will be provided a form as a confirmation by the agency that you have met the application requirements of the program. This form allows the agency to conduct a full audit of your SPI for any issues that may come up. If an audit is conducted, a check will be made out to the agency by the participating agency, and you will be responsible for paying that on your own. NOTE: The agency may require an audit of all participants, not just the ones that are reviewed. Please contact the agency of the agency that reviewed your SPI for more information. 2. Participants who choose to self-audit their SPI will need to have their account numbers and passwords updated before each new statement is generated by the vendor. Please update your password before the month, or every other month. If you receive a new email stating that a new password has been approved on your behalf, please go to and update your account information there. 3. In order to participate in this program we require that participating agencies have their payroll information on file with OSI as well as a Social Security number or one other acceptable proof of identity.

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