Voluntary Compliance Self-Audit Checklist Question Title * 1. Enter reference # from Voluntary Compliance letter: Question Title * 2. Was the company's name and address on the mailing received accurate? Yes No Question Title * 3. If answered No to the previous question, provide the correct company information: Company name Company address 1 Company address 2 Company City Company State Company ZIP Code Question Title * 4. Is the company incorporated in New York State? Yes No N/A Question Title * 5. Does the company have any of the following? Uncashed Payroll Checks due to New York State Residents Uncashed Vendor/ Accounts Payable Checks Uncashed Customer Refunds Accounts Payable Credit Balances Merchandise Credits Gift Cards/ Certificates Over 1 year Over 1 year Uncashed Payroll Checks due to New York State Residents Over 1 year Uncashed Vendor/ Accounts Payable Checks Over 1 year Uncashed Customer Refunds Over 1 year Accounts Payable Credit Balances Over 1 year Merchandise Credits Over 1 year Gift Cards/ Certificates Over 3 years Over 3 years Uncashed Payroll Checks due to New York State Residents Over 3 years Uncashed Vendor/ Accounts Payable Checks Over 3 years Uncashed Customer Refunds Over 3 years Accounts Payable Credit Balances Over 3 years Merchandise Credits Over 3 years Gift Cards/ Certificates Question Title * 6. Describe how your company tracks these items: Uncashed Payroll Checks Uncashed Vendor/ Accounts Payable Checks Unused Customer Refunds Accounts Payable Credit Balances Merchandise Credits Gift Cards/ Certificates Move to a suspense account Move to a suspense account Uncashed Payroll Checks Move to a suspense account Uncashed Vendor/ Accounts Payable Checks Move to a suspense account Unused Customer Refunds Move to a suspense account Accounts Payable Credit Balances Move to a suspense account Merchandise Credits Move to a suspense account Gift Cards/ Certificates Remain on the outstanding list Remain on the outstanding list Uncashed Payroll Checks Remain on the outstanding list Uncashed Vendor/ Accounts Payable Checks Remain on the outstanding list Unused Customer Refunds Remain on the outstanding list Accounts Payable Credit Balances Remain on the outstanding list Merchandise Credits Remain on the outstanding list Gift Cards/ Certificates Track and report to the appropriate state's unclaimed funds program Track and report to the appropriate state's unclaimed funds program Uncashed Payroll Checks Track and report to the appropriate state's unclaimed funds program Uncashed Vendor/ Accounts Payable Checks Track and report to the appropriate state's unclaimed funds program Unused Customer Refunds Track and report to the appropriate state's unclaimed funds program Accounts Payable Credit Balances Track and report to the appropriate state's unclaimed funds program Merchandise Credits Track and report to the appropriate state's unclaimed funds program Gift Cards/ Certificates Write-off Write-off Uncashed Payroll Checks Write-off Uncashed Vendor/ Accounts Payable Checks Write-off Unused Customer Refunds Write-off Accounts Payable Credit Balances Write-off Merchandise Credits Write-off Gift Cards/ Certificates Other (please specify) Question Title * 7. Does the company have unclaimed amounts held for unknown owners? Yes No N/A Question Title * 8. If the company reports unclaimed funds under a related business, provide the business information: Business name FEIN Question Title * 9. Provide a contact for further correspondence (if needed): Name Title Phone Email Done
