Word document

Voucher Changes and Reminders:

This is a new full-page voucher in our “Updated Format”. When reproducing this voucher, the gray constrained data boxes and gray delimiters should not be reproduced as they are for handwritten vouchers only. The “All layers” button shows the printed variable data that should be populated on your reproduced form in reference to the constrained data box locations. The only gray boxes that you will reproduce are the “Payment type” check boxes. These check boxes are exactly 1X2 grids and must be printed at 15% black. Your reproduced voucher must match the placement shown on the “With grid & data” layer including form format, border lines, field labels, target marks, QR code, variable data, and scanline.

This voucher is non-year specific. The QR code must show “0000” for the Form Year.

The form number, revision date, and version number are located on grid rows 59 and 60. The version number printed on the form must match the version number in the QR code.

Your NACTP ID is required in the area for Software Vendor ID, grid row 60. The vendor software version number is also shown on grid row 60. (The vendor software version number is different than the DOR version number that is included in the QR code.)

The vendor software version on grid row 60 must match the software version in positions 48 and 49 of the scanline. Start with version “00” for testing. Increase the software version incrementally, beginning with “01” after your form has been approved for production.

The “Tax year ending” date will be used in reverse order (YYYY/MM/DD) in the scanline.

The “Tax Type Code” for Pass-through Entity Elective tax is 210 in the scanline.

The “ID Type” in the scanline is a two-digit number with each digit having a separate location. The first digit is in position 43 and the second digit is in scanline position 4.

Mailing instructions are included on the face of the voucher.

Mailing Address for OR-21-V Vouchers:

If you are mailing a payment without a return, mail your check, money order, or cashier’s check with Form OR-21-V to:

Oregon Department of Revenue
PO Box 14950
Salem OR 97309-0950

Characters included in the QR Code (separate each field with an underscore):

Field Name Characters Notes or example ______________________ __________________________
1 Form Name Unlimited Form OR-21-V. Include dashes and spaces.
2 Form ID 4 “2200” Four-digit number found in the “2022 Substitute Form and 1-D Barcode .
Requirements” document.
3 Form Year 4 “0000” non-year specific voucher (constant)
4 DOR Form Revision 2 “01” for version of the form within the form year.
5 Vendor ID Code 4 “0000” NACTP Number (required)
6 Agency Website 26 “https://www.oregon.gov/dor”

QR Code: “Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor”

OR-21-V Scannable Voucher Specifications

To achieve reliable processing, all documents should be free of tears or cut-offs.

Font: Courier, standard print, or non-proportional font.
Font (Scanline): OCR-A point size 12.
Type of Paper: 24 lb, OCR bond.
Horizontal Spacing: 10 characters per inch, 96 character maximum.
Vertical Spacing: 6 characters per inch.
Print Standard: American National Standards Institute (ANSI) standard X 3.17-1976 for Y quality. Characters must be sharp and clear, without ghosting.
Back of Form: This area is used for an endorsement; there should be no printing.
Finished Size: Form: 8 1/2 inches X 11 inches.
Equipment: ibml I mageTrac 6400 series high speed scanner: scans OCR and MICR characters, endorses, encodes, and images.
Testing: All documents will be tested on Department of Revenue equipment before production runs.

Name Control

The Name Control field is defined as the first four alphanumeric characters of the legal name of the filer (PTE legal name) listed on tax return.
Only capital letters should be used.
The Name Control field is left justified in the scanline and if it is less than four characters it must be zero filled.
All punctuation and spaces must be stripped out for use in the scanline.

Examples of how the Name Control field should appear in the scanline and on the form are shown below:

Example of standard four letters:
Example Appearance in Scanline Appearance on Form
Main Street LLC MAIN MAIN STREET LLC

Example of 2-part name:
Example Appearance in Scanline Appearance on Form
Mc Donald Trucking MCDO MC DONALD TRUCKING
O’Neil Roses ONEI O’NEIL ROSES

Note: Run the 2-part names together and remove punctuation.

Example of 2 names with special characters and fewer than four letters:

Example Appearance in Scanline Appearance on Form
Jim & Joe’s Transport JIMJ JIM & JOE’S TRANSPORT
Note: All spaces and special character are removed.

Computing Check Digit Figure for Scannable Voucher OR-21-V

The Check Digit is computed using Luhn Modulus 10 as follows:

Convert all alpha characters to numeric values. No punctuation.
Each Alpha character is converted to its EBCDIC numeric value (see table)

A B C D E F G H I
J K L M N O P Q R
S T U V W X Y Z
1 2 3 4 5 6 7 8 9

Multiply each digit in the converted scanline by a weighting factor. The weighting factors are based on digit’s position in the scanline. Starting from the right most digit (including the check digit) double every second digit until you have reached the left most digit.
Sum the digits that resulted from the multiplication with the weighting factors.
Subtract the sum from the next highest multiple of 10. The result is the Check Digit.

Example for Scannable Voucher

OCR Scanline
Tax Type Code 210 -Three Digits - “210” for Pass-through Entity Elective Tax
ID Type (Second digit) 2 - One Digit – “2” for FEIN
Primary ID 000000123456789 - Fifteen Digits – FEIN only for OR-21-V, Right Justified, Leading Zeros.
Name Control ABCD - Four Characters Alphanumeric – Left Justified and Zero Filled if less than 4 characters.
Secondary ID 000000000 - Nine Digits – Zero filled - Constant
Period End Date 20221231 - Eight Digits - YYYYMMDD
Payment Type Code 01 - Two Digits – “01” for Original Return Payment. (See payment types listed in the grid layout below)
ID Type (First digit) 0 - One Digit – “0” for FEIN
Software Developer ID 0000 - Four Digits - (NACTP ID number)
Software Version 00 - Two Digits - (Software version)
Check Digit * - One Digit - Luhn Mod10, Note: “*” represents the check digit
Scanline: 2102000000123456789ABCD00000000020221231010000000*

Multiply each digit in the Scanline by its weighting factor.
Scanline 2 1 0 2 0 0 0 0 0 0 1 2 3 4 5 6 7 8 9 A B C D 0 0 0 0 0 0 0 0 0 2 0 2 2 1 2 3 1 0 1 0 0 0 0 0 0 0 *
Scanline after Name Control 2 1 0 2 0 0 0 0 0 0 1 2 3 4 5 6 7 8 9 1 2 3 4 0 0 0 0 0 0 0 0 0 2 0 2 2 1 2 3 1 0 1 0 0 0 0 0 0 0 *
Multiply by 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2
Total 4 1 0 2 0 0 0 0 0 0 2 2 6 4 10 6 14 8 18 1 4 3 8 0 0 0 0 0 0 0 0 0 4 0 4 2 2 2 6 1 0 1 0 0 0 0 0 0 0

Sum the digits that resulted from the multiplication with the weighting factors. Note: Two-digit numbers such as 10, 14, and 18 will be added as 1+0, 1+4, and 1+8.

Sum =4+1+0+2+0+0+0+0+0+0+2+2+6+4+1+0+6+1+4+8+1+8+1+4+3+8+0+0+0+0+0+0+0+0+0+4+0+4+2+2+2+6+1+0+1+0+0+0+0+0+0+0 = 88

Subtract the sum from the next highest multiple of 10:
90 - 88 = 2 = Check Digit.

Final Scanline (OCR-A Font): 2102000000123456789ABCD000000000202212310100000002

Definitions: ALPHA = A-Z (MUST BE CAPS)
NUMERIC = 0-9
ALPHANUMERIC = A-Z, 0-9
LEFT JUSTIFY = LJ
RIGHT JUSTIFY = RJ

! – Indicates changes for Tax Year 2022 version

Identification Begin End Maximum Field Changes
Line
Print Print Field Description
Number
Position Position Length
1-4 Blank !
5 Target Mark 6 7 2 Conventional form size/style: exactly 1X2 grids !
5 Form identifier 12 25 14 “Form OR-21-V” !
5 Agency title Label 59 74 16 “Oregon Department of Revenue" !
5 Target Mark 79 80 2 Conventional form size/style: exactly 1X2 grids !
6 Form title Label 12 48 37 "Pass-through Entity Elective Tax Payment Voucher" !
7 Blank !
8 Page 1 of 1 Label 12 16 5 "Page 1 of 1" !
8 Form instructions Label 18 30 13 “· Use UPPERCASE letters.” !
8 Form instructions Label 31 41 11 “· Use blue or black ink.” !
8 Form instructions Label 41 52 12 “· Print actual size (100%).” !
8 Form instructions Label 53 71 19 “· Don't submit photocopies or use staples.” !
9 Form separator line 6 80 75 Bold border line (1.5pt) - Conventional form size/style !
9 Tax year beginning (MM/DD/YYYY) Label 6 21 16 "Tax year beginning (MM/DD/YYYY)" !
9 Tax year ending (MM/DD/YYYY) Label 29 42 14 "Tax year ending (MM/DD/YYYY)" !
10 Tax year beginning (MM/DD/YYYY) Area 6 26 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
10 Tax year ending (MM/DD/YYYY) Area 29 49 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
11 Tax year beginning (MM/DD/YYYY) Area 6 26 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
11 Tax year beginning (MM/DD/YYYY) 6 15 10 MM/DD/YYYY !
11 Tax year ending (MM/DD/YYYY) Area 29 49 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
11 Tax year ending (MM/DD/YYYY) 29 38 10 MM/DD/YYYY !
12 Form separator line 6 80 75 Border line (.5pt) - Conventional form size/style !
13 Contact name Label 6 12 7 "Contact name" !
14 Contact name Label 6 12 7 "Contact name" !
14 Contact name Area 6 80 75 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
15 Contact name Area 6 80 75 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
15 Contact name 6 79 74 Alphanumeric, LJ, ALL CAPS !
16 Legal name of filer on tax return Label 6 19 14 "Legal name of filer on tax return" !
17 Legal name of filer on tax return Label 6 19 14 "Legal name of filer on tax return" !
17 Legal name of filer on tax return Area 6 80 75 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
18 Legal name of filer on tax return Area 6 80 75 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
18 Legal name of filer on tax return 6 79 74 Alphanumeric, LJ, ALL CAPS !
19 Federal employer identification number (FEIN) Label 6 25 20 "Federal employer identification number (FEIN)" !
20 Federal employer identification number (FEIN) Area 6 26 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
21 Federal employer identification number (FEIN) Area 6 26 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
21 Federal employer identification number (FEIN) 6 15 10 Numeric, LJ, 99-9999999 !
22 Filer address Label 6 11 6 "Filer address" !
23 Filer address Area 6 76 71 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
24 Filer address Area 6 76 71 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
24 Filer address 6 40 35 Alphanumeric, LJ, ALL CAPS !
25 City Label 6 7 2 "City" !
25 State Label 53 55 3 "State" !
25 ZIP code Label 60 63 4 "ZIP code" !
26 City Area 6 50 45 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
26 State Area 53 57 5 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
26 ZIP code Area 60 80 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
27 City Area 6 50 45 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
27 City 6 27 22 Alpha, LJ, ALL CAPS !
27 State Area 53 57 5 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
27 State 53 54 2 Alpha, LJ, ALL CAPS !
27 ZIP code Area 60 80 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
27 ZIP code 60 69 10 Alphanumeric, LJ, "XXXXX-XXXX" !
28 Contact phone Label 6 12 7 "Contact phone" !
29 Contact phone Area 6 30 25 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
30 Contact phone Area 6 30 25 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
30 Contact phone 6 17 12 Numeric, LJ, "999-999-9999" !
31-44 Blank !
45 Form separator line 50 80 31 Border line (.5pt) - Conventional form size/style !
45 Payment type and amount Area 50 80 31 Conventional form size/style !
46 Payment type and amount Area 50 80 31 Conventional form size/style !
46 Payment type Label 52 65 14 “Payment type (check one)” !
47 Payment type and amount Area 50 80 31 Conventional form size/style !
48 Voucher Instructions 6 43 38 "Want to make your payment online? Find options at www.oregon.gov/dor." !
48 Payment type and amount Area 50 80 31 Conventional form size/style !
48 Check box Area 52 53 2 Conventional form size/style: exactly 1X2 grids. Reproduce check box at 15% black. !
48 Check box Mark 52 52 1 “X”, LJ, if Original return payment, otherwise leave blank. !
48 Original return Label 55 61 7 “Original return” !
49 Voucher Instructions 6 44 39 "Use this voucher only if you are making a payment without a return. Make" !
49 Payment type and amount Area 50 80 31 Conventional form size/style !
50 Voucher Instructions 6 46 41 "your check, money order, or cashier’s check payable to the Oregon Department of" !
50 Payment type and amount Area 50 80 31 Conventional form size/style !
50 Check box Area 52 53 2 Conventional form size/style: exactly 1X2 grids. Reproduce check box at 15% black. !
50 Check box Mark 52 52 1 “X”, LJ, if Estimated payment, otherwise leave blank. !
50 Estimated payment Label 55 64 10 "Estimated payment" !
51 Voucher Instructions 6 45 40 "Revenue. Write “Form OR-21-V,” the filer’s name, federal employer identification" !
51 Voucher Instructions 6 46 41 "number (FEIN), the tax year beginning and ending dates, and a daytime phone on" !
51 Payment type and amount Area 50 80 31 Conventional form size/style !
52 Voucher Instructions 6 46 41 "number (FEIN), the tax year beginning and ending dates, and a daytime phone on" !
52 Voucher Instructions 6 38 33 "your payment. Don’t mail cash. Mail the voucher and payment to:" !
52 Payment type and amount Area 50 80 31 Conventional form size/style !
52 Check box Area 52 53 2 Conventional form size/style: exactly 1X2 grids. Reproduce check box at 15% black. !
52 Check box Mark 52 52 1 “X”, LJ, if Amended return payment, otherwise leave blank. !
52 Amended return Label 55 62 8 “Amended return” !
53 Voucher Instructions 6 38 33 "your payment. Don’t mail cash. Mail the voucher and payment to:" !
53 DOR Mailing Address 6 23 18 "Oregon Department of Revenue" !
53 Payment type and amount Area 50 80 31 Conventional form size/style !
54 DOR Mailing Address 6 23 18 "Oregon Department of Revenue" !
54 DOR Mailing Address 6 14 9 "PO Box 14950" !
54 Payment type and amount Area 50 80 31 Conventional form size/style !
55 DOR Mailing Address 6 14 9 "PO Box 14950" !
55 DOR Mailing Address 6 18 13 "Salem OR 97309-0950" !
55 Payment type and amount Area 50 80 31 Conventional form size/style !
56 Payment type and amount Area 50 80 31 Conventional form size/style !
57 Form separator line 6 49 44 Bold border line (1.5pt) - Conventional form size/style !
57 Payment type and amount Area 50 80 31 Conventional form size/style !
57 Enter payment amount Label 52 63 12 "Enter payment amount" !
58 Payment type and amount Area 50 80 31 Conventional form size/style !
59 QR Code 12 19 8 See QR Code Specifications. "Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor" The last four digits showing as "0000" must be your NACTP Vendor ID. !
59 Form number 23 28 6 "150-107-172" !
59 Revision date, version number 23 32 10 "(Rev. 12-22-21, ver. 01)" !
59 Payment type and amount Area 50 80 31 Conventional form size/style !
59 Payment Area 55 81 27 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
60 QR Code 12 19 8 See QR Code Specifications. "Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor" The last four digits showing as "0000" must be your NACTP Vendor ID. !
60 Revision date, version number 23 32 10 "(Rev. 12-22-21, ver. 01)" !
60 Software vendor identifier 40 43 4 NACTP ID # of Software Company producing form, LJ !
60 Software version 45 46 2 Vendor software version. Start with version”00” for testing. Please increase the software version incrementally, beginning with “01” after your form has been approved for production. !
60 Payment type and amount Area 50 80 31 Conventional form size/style !
60 Dollar sign 52 52 1 "$" !
60 Payment Area 55 75 21 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
60 Payment amount 66 75 10 Numeric, RJ, "99,999,999" !
60 Decimal point 76 76 1 "." !
60 Payment Area 77 81 5 Conventional form size/style. Do not reproduce, for handwritten vouchers only !
60 Payment amount 77 78 2 Numeric, LJ – Round to "00" !
61 QR Code 12 19 8 See QR Code Specifications. "Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor" The last four digits showing as "0000" must be your NACTP Vendor ID. !
62 QR Code 12 19 8 See QR Code Specifications. "Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor" The last four digits showing as "0000" must be your NACTP Vendor ID. !
63 Target Mark 6 7 2 Conventional form size/style: exactly 1X2 grids !
63 QR Code 12 19 8 See QR Code Specifications. "Form OR-21-V_2200_0000_01_0000_https://www.oregon.gov/dor" The last four digits showing as "0000" must be your NACTP Vendor ID. !
63 Scanline 31 80 50 The placement is grids 31-80. The Scanline must be printed using OCR-A font point size 12. !
63 Tax type code 31 33 3 Numeric - Constant - "210" for Pass-through Entity Elective Tax !
63 Scanline – ID type (Second digit) 34 34 1 Numeric - Constant - “2” for FEIN !
63 Scanline – Primary ID number 35 49 15 Numeric – 15 digits, format example (987654123456789), RJ, if the Primary ID number is less than 15 digits leading zeros are required (example 000000123456789). !
63 Scanline – Name control 50 53 4 Alphanumeric “ABCD”, ALL CAPS, LJ, Zero filled if less than 4 characters. First 4 characters of Legal name of filer on return. !
63 Scanline – Secondary ID 54 62 9 Numeric - Constant - “000000000” !
63 Scanline- Period date 63 70 8 Numeric - 8 digits - “YYYYMMDD” Same day in reverse order as "Tax year ending date" !
63 Scanline – Payment type code 71 72 2 Numeric - 2 digits, identified from the following list: !

Original Return Payment - “01”

Estimated Payment - “02”

Amended Return Payment - “03”
63 Scanline – ID type (First digit) 73 73 1 Numeric - Constant - “0” for FEIN !
63 Scanline – Software developer NACTP ID number 74 77 4 Numeric 4 digits !
63 Scanline – Developer’s software version 78 79 2 Numeric - 2 digits, start with version ”00” for testing. Please increase the software version incrementally, beginning with “01” after your form has been approved for production. !
63 Scanline – Check digit 80 80 1 Numeric – 1 digit - Calculated using Luhn Modulus 10 !
64-66 Blank !
66 End of page !

2022 Form OR-21-V Specifications

12

2007 Form OR-41-V Draft Specifications

Document checksum: 266618638

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