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Get and Sign Public Partnerships Direct 2017-2022 Form
405c2C. PPL will use to file required information returns to IRS.
Section 2
1. Social Security Number (SSN)
2. Payee Name
3. Phone
4. Payee Address
5. Participant Name
Section 3
AUTHORIZATION FOR SET-UP, CHANGE OR CANCELLATION
I authorize Public Partnerships, LLC (PPL) to process payments owed to me for services authorized by the West Virginia Personal Options self-directed program. Per my request,
PPL will deposit my payment directly to my bank or pay card account indicated below using...
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