Electronic Funds Transfer Enrollment Form Page 2
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4Office of Statewide Reporting and Accounting Policy
Page 2
that you receive your remittance advices
your payments via EFT, the enclosed form
from your financial institution in a user-
must be completed and signed by an
friendly format.
If upon receipt of the
authorized individual within your organization
remittance information, you have questions
and financial institution.
Enrollees must
regarding a payment, you should contact the
agree to all of the conditions on the
agency
whose
telephone
number
is
enrollment form.
Any questions from our
provided.
office will be directed to the individuals listed
on the form.
Activation of your EFT enrollment will occur
within 5 to 10 days from the time we receive
For your convenience, an enrollment form
your completed application form. After your
and
the
instructions
are
enclosed.
enrollment has been activated, payments to
Completed forms and a copy of a voided
you will be sent electronically in the normal
check should be mailed or faxed directly to
course of business, unless we are notified
the address below.
For confidentiality
otherwise, in writing.
reasons, do not return this form to any
State agency other than the Office of
Statewide Reporting and Accounting
If changes occur that affect your bank or
Policy (OSRAP). If you have any questions,
account information after submitting the
please contact OSRAP at:
enrollment form, contact our office
immediately at the telephone number or
LA Division of Administration
address listed below. Failure to do so may
Office of Statewide Reporting
result in lost payments. The State will
bear
no
responsibility
for
lost
or
and Accounting Policy
misdirected payments if it is determined
P.O. Box 94095
that you failed to notify us of changes or
Baton Rouge, LA 70804-9095
failed to provide correct information.
OSRAP Help Desk:
The State must identify payments to vendors
Phone
(225) 342-1097
via Electronic Funds Transfer (EFT) that are
FAX
(225) 342-0964
forwarded by the vendor to an account
outside of the United States in order to
I hope you will take advantage of this
comply with requirements of the United
payment method.
States Treasury Office of Foreign Assets
Control.
The rules are referred to as
Sincerely,
“International ACH Transaction (IAT) rules.”
ACH refers to Automated Clearing House
transactions, the common name given to
EFT transactions. In this case, IAT refers to
the bank
code
used to
identify the
John McLean, CPA
international ACH transactions. You must
Interim Director
check
yes
or
no
before
the
EFT
Enrollment Form can be processed. Yes
means receipts are
transferred to an
account outside of the U.S.
No means
receipts are not transferred to an account
outside of the U.S.
If you would like to continue receiving your
payments in the form of a check, you do not
need to respond. If you choose to receive
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