Collections Survey

Agency Name *

Agency Address *

Address Line 1

Address Line 2

City

State

Zip Code

Does your agency handle felonies, misdemeanors or ordinance violations that result in convictions? *

If no, which agency handles the above for you and how are they submitted to LCLE?

Who is the person responsible for completing the Act 250 (CVR), Act 440 (POST) and Act 832 (DAET) collections form(s)?

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Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Is the person responsible for completing the Act 250 (CVR), Act 440 (POST) and Act 832 (DAET) collections form(s) also responsible for submitting the collection transmittal form and remittances to LCLE? *

If no, indicate the person’s name, title, address and contact information below:

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Are there any obstacles your agency encounter in obtaining and/or providing the number of convictions, case numbers, etc. in completing the LCLE Collection Forms (Act 250, Act 440 and Act 832)? *

Please enter what are the obstacles below:

Do you require technical assistance in how to correctly complete the LCLE Collections Forms? *

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Collections Agency Survey

If you have any questions related to this form please contact: Kaitlyn Cooley at 225-342-1596 or Kaitlyn.Cooley@lcle.la.gov

Who is the person responsible for completing the Act 250 (CVR), Act 440 (POST) and Act 832 (DAET) collections form(s)?

If no, indicate the person’s name, title, address and contact information below: