Fee Exemption Petition Submission

Agency Contact: Direct Deposit Fee Exemption
Office of the Comptroller
325 W. Adams Street
Springfield, IL 62704
DDFeeExemption@IllinoisComptroller.Gov

Pursuant to 15 ILCS 405/9.03, all State payments that exceed the allowable limit in a fiscal year must be made through direct deposit. Vendors or employees requesting an exemption from this direct deposit mandate due to hardship may petition for fee exemption status. Petitioners will receive an approval or denial notice via email at a later date.

NOTE: ^* Indicates Required Fields

SECTION 1: CONTACT INFORMATION

Contact Name:

First^*:

MI:

Last^*:

Address^*:

Address Continued

City^*:

State^*:

Zip^*:

Paying Agency ^*:

DayTime Phone^*:

E-mail^*:

Re-Enter e-mail for verification^*:

SECTION 2: TAXPAYER IDENTIFICATION

Taxpayer Identification Number^*: ¹

Validate TIN^*: No Dashes or Spaces Please

¹A copy of the IOC's Identification protection policy can be found on our website at:
https://illinoiscomptroller.gov/about/identity-protection-policy (opens in new tab)

SECTION 3: REASON FOR EXEMPTION

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By submitting this form, you acknowledge that the content is truthful and accurate to the best of your knowledge. You further acknowledge that it is your intent that submission acts as your digital signature in place of your manual signature, and that your digital signature has the same legal effect as your manual signature.

Fee Exemption Petition Submission

SECTION 1: CONTACT INFORMATION

Contact Name:

SECTION 2: TAXPAYER IDENTIFICATION

SECTION 3: REASON FOR EXEMPTION

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