In order to complete the Form W-9, you must include the following information: Your full name Social security number and taxpayer identification number Date of birth U.S. employer or taxpayer identification number The amount to be reported In addition, the following item must be noted on the payment form: “Payment Due to Federal Agency” W-9 Filing Form Guide. U.S. Employer Identification Number — South Carolina Health Care Service Corporation. W-10, Employer's Withholding Tax Payment to You — South Carolina Health Care Service Corporation. Note. In South Carolina, the state also has an individual FICA tax withholding responsibility for any mayor that did not remit Social Security and Medicare taxes. Form W-10, Employer's Withheld Federal Insurance Tax — South Carolina Health Care Service Corporation. W-10 South Carolina Health Care Service Corporation. Enter your payment into the appropriate box. Form W-10A, Nonresidents Withheld FICA Tax Payment to you — South Carolina Health Care Service Corporation. This form is useful when you have not filed U.S. taxes for more than five years, and you want to report payments that you will not receive back in the future. Federal tax information for nonresidents. South Carolina Health Care Service Corporation. Federal tax information for residents. South Carolina Health Care Service Corporation. What to do if you have been charged any state income tax in 2017. You may be able to avoid a state tax liability by filing a delinquent state tax return. If you owe a state tax, you must pay the tax if you do not meet the statutory deadline for payment. State tax return filing deadlines are listed below and may change annually. The State of South Carolina Department of Revenue has a list of delinquent state tax debtors. You may be able to request a state tax exemption from the South Carolina Department of Revenue, or a special assessment from SC Dept. of Revenue, for a delinquent tax debt. The Special Assessment Form may be available at the Office of the State Comptroller or the Business Tax Exemptions Section, at: S.C. Tax Exemptions, Special Assessments Division, P.O. Box 1460, Columbia, South Carolina 29 or call. You may also contact the state court services division or the South Carolina Superior Court's tax division.