"Billing Information Form" - New York

Billing Information Form is a legal document that was released by the New York State Department of Public Service - a government authority operating within New York.

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Download "Billing Information Form" - New York

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STATE OF NEW YORK
DEPARTMENT OF PUBLIC SERVICE
THREE EMPIRE STATE PLAZA, ALBANY, NY 12223-1350
Please E-mail to secretary@dps.ny.gov, OR Fax to: (518) 474-9842.
BILLING INFORMATION FORM
(Please clearly print or type all information below.)
Name and Title of Authorized Representative ___________________________________________________
Name of Business / Requester _______________________________________________________________
Address_________________________________________________________________________________
(street)
(city)
(state)
(zip)
Contact Information________________________________________________________________________
(phone)
(fax)
(email)
Business I.D. No. _________________________________________________________________________
Business' Reference or Purchase Order No. _____________________________________________________
Delivery Account Name and No. __________________________________________________________
By submitting this form, I hereby agree to pay fees associated with the following request.
Detailed description of requested records: (please be specific)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Number of pages requested (if known)___________
Fees
According to 16 NYCRR §6-1.2, unless otherwise prescribed by statute, photocopies of official documents (public records) will be
furnished in accordance with the following pricing schedule:
(a) The fee for duplication of commission records from original 8 ½ " x 11" and 8 ½" x 15" shall be 25 cents per page.
(b) The fee for special reproductions such as photocopies of large items, copies of microfilmed records, etc., shall be based upon
the average unit cost of copying a record, excluding fixed costs of the Department, such as operator salaries overhead.
(c) The fee for duplication of commission records onto a CD shall be $4 per CD.
Copying fees are not charged to: (1) Federal agencies, New York State agencies (including authorities) or local agencies in New York;
(2) other states’ Public Service Commissions or Public Utility Commissions; (3) Consumers, or their designated representatives,
for a single copy of their case files; (4) Not-for-profit organizations; or (5) Requesters, where the records sought total fewer than
20 pages; this 20 page limit applies to requests of the same person, or firm, within any 30-day period.
State Finance Law
Section 18(4) of the State Finance Law authorizes charging interest on the outstanding balance of debt and a $10 late fee (on invoices
60 days past due). Subdivision 5 of that section authorizes a collection fee that may not exceed 22 percent (on invoices 90 days past
due). Section 19 of the State Finance Law authorizes a charge for returned checks.
INTERNAL USE ONLY
(Office of General Counsel/Central Operations)
(Finance and Budget)
Number of Pages Photocopied __________
Billing Date ________________
Number of CDs Ordered ______________
Invoice Number ______________
Date filled ______________
Bill Amount ________________
Person taking request _______________________
Interest Amount ________________
Person filling order _________________________
STATE OF NEW YORK
DEPARTMENT OF PUBLIC SERVICE
THREE EMPIRE STATE PLAZA, ALBANY, NY 12223-1350
Please E-mail to secretary@dps.ny.gov, OR Fax to: (518) 474-9842.
BILLING INFORMATION FORM
(Please clearly print or type all information below.)
Name and Title of Authorized Representative ___________________________________________________
Name of Business / Requester _______________________________________________________________
Address_________________________________________________________________________________
(street)
(city)
(state)
(zip)
Contact Information________________________________________________________________________
(phone)
(fax)
(email)
Business I.D. No. _________________________________________________________________________
Business' Reference or Purchase Order No. _____________________________________________________
Delivery Account Name and No. __________________________________________________________
By submitting this form, I hereby agree to pay fees associated with the following request.
Detailed description of requested records: (please be specific)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Number of pages requested (if known)___________
Fees
According to 16 NYCRR §6-1.2, unless otherwise prescribed by statute, photocopies of official documents (public records) will be
furnished in accordance with the following pricing schedule:
(a) The fee for duplication of commission records from original 8 ½ " x 11" and 8 ½" x 15" shall be 25 cents per page.
(b) The fee for special reproductions such as photocopies of large items, copies of microfilmed records, etc., shall be based upon
the average unit cost of copying a record, excluding fixed costs of the Department, such as operator salaries overhead.
(c) The fee for duplication of commission records onto a CD shall be $4 per CD.
Copying fees are not charged to: (1) Federal agencies, New York State agencies (including authorities) or local agencies in New York;
(2) other states’ Public Service Commissions or Public Utility Commissions; (3) Consumers, or their designated representatives,
for a single copy of their case files; (4) Not-for-profit organizations; or (5) Requesters, where the records sought total fewer than
20 pages; this 20 page limit applies to requests of the same person, or firm, within any 30-day period.
State Finance Law
Section 18(4) of the State Finance Law authorizes charging interest on the outstanding balance of debt and a $10 late fee (on invoices
60 days past due). Subdivision 5 of that section authorizes a collection fee that may not exceed 22 percent (on invoices 90 days past
due). Section 19 of the State Finance Law authorizes a charge for returned checks.
INTERNAL USE ONLY
(Office of General Counsel/Central Operations)
(Finance and Budget)
Number of Pages Photocopied __________
Billing Date ________________
Number of CDs Ordered ______________
Invoice Number ______________
Date filled ______________
Bill Amount ________________
Person taking request _______________________
Interest Amount ________________
Person filling order _________________________