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Collections Survey
Anthony Myles
2022-10-20T14:34:32-05:00
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
Please enable JavaScript in your browser to complete this form.
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Step
1
of 2
Agency Name
*
Agency Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Does your agency handle felonies, misdemeanors or ordinance violations that result in convictions?
*
YES
NO
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)?
Layout
Name
*
First
Last
Email
*
Phone
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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?
*
YES
NO
If no, indicate the person’s name, title, address and contact information below:
Layout (copy)
Name
*
First
Last
Title
Phone
Email
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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)?
*
YES
NO
Please enter what are the obstacles below:
Do you require technical assistance in how to correctly complete the LCLE Collections Forms?
*
YES
NO
Layout
If yes, click on which forms (Act 250, Act 440, Act 832) and what type of technical assistance do you need?
ACT 250
ACT 440
ACT 832
Please enter type of assistance needed below:
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