Accounts and Reports Setoff Program
State Agency
DESCRIPTION OF DATA ELEMENTS FOR DELINQUENT DEBTS FORM
Debtor ID Number (9 characters)
The debtor's EIN or SSN.
Debtor ID code (1 character)
This code is used to identify the type of debtor identification number being submitted.
1 = Employer Identification Number (EIN)
2 = Social Security Number (SSN)
Creditor Agency Number (5 characters)
The State Agency number used for submitting debts for setoff is the three digit
agency number followed by the two digit division number.
First Name (12 characters)
The debtor's first name.
Middle Initial (1 character)
The debtor's middle initial.
Last Name or Business Name (25 characters)
The debtor's last name or the business name if the debtor is a business.
Account ID Number (14 characters)
A unique number, other than the debtor identification number, assigned by the creditor
agency to a debt. The use of this field is optional and the creditor agency may use this
field if it will be of assistance in locating or identifying particular debts. If a creditor
agency elects to not use this option, this field should be left blank.
Type of Debt Code (2 characters)
This code is used to identify the general type of debt being submitted.
11 = Tax
29 = Other
Type of Debt Description (30 characters)
A description of the debt owed.
Amount (9 characters)
The amount of the debt owed. No commas permitted. Decimal point must be used.
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Page last modified on:
June 29, 2012