83 Ill. Adm. Code 1329.APPENDIX
B Format of Carrier Remittance Transmittal
Section 1329.APPENDIX B Format of Carrier Remittance
Transmittal
WIRELINE / VoIP CARRIER
REMITTANCE FORM FOR ILLINOIS 9-1-1 SURCHARGE
CARRIER
NAME
CARRIER FEIN
CARRIER ADDRESS
CITY/ST/ZIP
CONTACT NAME
CONTACT PHONE #
CHECK NUMBER
CHECK DATE
REMITTANCE BREAKDOWN:
REMIT MONTH / YEAR
Service Type
Number
Connections
Amount
Remitted
Wireline $
-
Interconnected VoIP $
-
Less 3% Admin if withheld
(Wireline and VoIP only) 3% $
-
*
* If remitting multiple months, please
attach remittance detail by month on a separate page.
-
The surcharge rate
is $0.87 per connection, per month, for connections located outside of the City
of Chicago; see section 20 of the Emergency Telephone System Act.
-
Pre-paid wireless
surcharge should be remitted to the Department of Revenue. Contact them, or
visit http://www.tax.illinois.gov for further information.
Send Check and remittance form to:
Illinois State Police
911 Administrative Support Command
911 Surcharge
801 South 7
th
Street
Springfield IL 62703
POST-PAID
WIRELESS CARRIER REMITTANCE FORM FOR ILLINOIS 9-1-1 SURCHARGE
CARRIER NAME
CARRIER FEIN
CARRIER ADDRESS
CITY/ST/ZIP
CONTACT NAME
CONTACT PHONE #
CHECK
NUMBER
CHECK DATE
REMITTANCE BREAKDOWN:
-
The surcharge
rate is $0.87 per connection, per month, for connections located outside of the
City of Chicago; see section 20 of the Emergency Telephone System Act.
-
Post-paid
wireless carriers must also email corresponding subscriber file to:
911_Admin_Support@isp.state.il.us.
Noncompliance will result in
penalties.
-
Per statute,
wireless carriers cannot withhold 3% for admin until July 1, 2022.
-
Pre-paid
wireless surcharge should be remitted to the Department of Revenue. Contact
them, or visit http://www.tax.illinois.gov for further information.
Send
Check and remittance form to:
Illinois
State Police
911
Administrative Support Command
911
Surcharge
801
South 7
th
Street
Springfield IL 62703