Most Commonly Used Forms
- Instructions for Payment of 9-1-1 Charges Using EFT Credit (Form 4668)
- Retailer's Prepaid Wireless 9-1-1 Surcharge Form (Form 5012)
- Service Supplier's State 9-1-1 Charge Form (Form 5013)
- Electronic Funds Transfer (EFT) Application - 9-1-1 Charges (Form 4103)
To ensure proper receipt of State 9-1-1 Charges and Prepaid Wireless 9-1-1 Surcharges, all remittances must include either a Retailer's Prepaid Wireless 9-1-1 Surcharge Form (Form 5012) or a Service Supplier's State 9-1-1 Charge Form (Form 5013). The Forms 5012 or 5013 must be completed according to the form instructions.
Forms and check payments can be mailed to:
Michigan Department of Treasury
Special Taxes Division/Misc. Taxes and Fees
PO Box 30781
Lansing, MI 48909-8281
Complete the Electronic Funds Transfer (EFT) Application - 9-1-1 Charges (Form 4103) to make payments electronically.
Emergency 9-1-1 Program
The Department of Treasury is responsible for the financial administration of the emergency 9-1-1 program, which includes processing quarterly payments received from communication service suppliers (CSS) and monthly payments received from prepaid wireless telecommunication service sellers (PWTSS), making distributions to the counties, local exchange providers, and the Public Safety Answering Points (PSAPs).
Effective January 1, 2013, all CSS operating within a 9-1-1 service district are required to bill and collect a State 9-1-1 charge from all users, except users of prepaid wireless service. The State 9-1-1 charges collected by the CSS shall be remitted quarterly to the Michigan Department of Treasury along with a Service Supplier's State 9-1-1 Charge Form (Form 5013). All PWTSS are required to collect a Prepaid Wireless 9-1-1 Surcharge for each retail transaction occurring in Michigan. The prepaid wireless 9-1-1 surcharges collected shall be remitted to the Michigan Department of Treasury monthly along with a Retailer's Prepaid Wireless 9-1-1 Surcharge Form (Form 5012).
From July 1, 2008 to December 31, 2012, all communication service suppliers/resellers and commercial mobile radio service suppliers operating in Michigan were required to bill and collect a State 9-1-1 charge and a County 9-1-1 charge from all service users, and/or an Emergency 9-1-1 charge from prepaid customers. Reports and remittance of charges were due on or before the 30th day of the month after the end of the quarter.