Payment Verification Form Information

All individuals and businesses that are due reimbursements/payments from a state agency will receive a letter and Payment Verification Form to complete and return to the Office of the State Controller (OSC). These payments could be related to performing a service, providing goods or may be a one-time reimbursement for an overpayment or other transaction.

You may receive a Payment Verification Form if you perform any of the following services:

  • Read to the blind
  • Interpret for the deaf
  • Consult for a state agency
  • Serve as a contractor for a state agency
  • Coach
  • Speak at a conference or seminar
  • Provide legal or other counsel

This form is sent as a courtesy so that the recipient (individual or business) can verify and ensure all of the printed information on the form is correct and up to date. For example, it is important that the Tax Identification Number (social security number or federal tax identification number), vendor name and address information are correct. Additionally, it is helpful that other general information (Individual and Business Characteristics parts I and II and phone/contact data) on the form is completed for informational purposes.

Completing and returning this form does not affect your Social Security payments, tax refunds, welfare checks, AFDC payments or other entitlement checks. If you choose not to complete this form, another one will automatically be mailed to you in approximately two months.

The links below may be helpful when completing this form. In fact, the Field Descriptions link will walk you through each field on the form and explain what information is needed in each field. If you should have additional questions, please contact the OSC Support Services Center at 919-707-0795.

  • Payment Verification Letter
    This link will show you a generic copy of the letter you have received.
  • Payment Verification Form
    This link will show you the form and allow you to click on the various fields to view a description of the form and what information goes in the field.
  • Field Descriptions
    This link will take you to the master description listing for the fields on the form.  You may print the page to refer to while completing the form.
  • Electronic Payment Form
    This link will take you to the electronic payment form to have your payment deposited directly into your bank account.

NOTE:  The specialists at the OSC Support Services Center do not know what agency will be sending you a payment(s). For payment information you will need to contact the state agency directly that is processing your payment(s).