Form 3881 - Ach Vendor Miscellaneous Payment Enrollment

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Department of the Treasury - Internal Revenue Service
3881
OMB Number
Form
ACH Vendor/Miscellaneous Payment Enrollment
1510-0056
(April 2016)
(See Instructions on Page 2)
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information
processed through the Direct Deposit Program. Recipients of these payments should bring this information to the attention of their
financial institution when presenting this form for completion.
PAPERWORK REDUCTION ACT NOTICE. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your
response is voluntary. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become
material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by code section
6103. The estimated average time to complete this form is 15 minutes. If you have comments concerning the accuracy of this time estimate or
suggestions for making this form simpler, we will be happy to hear from you. You can write to the Tax Products Coordinating Committee, SE:W:CAR:
MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224.
PRIVACY ACT STATEMENT. The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on
this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit
payment data, by electronic means to vendor's financial institution. Failure to provide the required information may delay or prevent the receipt of
payments through the Automated Clearing House Payment System.
1. Agency Information
Federal program agency
Agency identifier
Agency Location Code (ALC)
ACH format
(check one)
CCD+
CTX
Address
Contact person name
Telephone number
FAX number
2. Payee/Company Information
Name
SSN or Taxpayer ID number
Address
Contact person name
Contact email address
Telephone number
3. Financial Institution Information
Name
Address
(optional)
Contact at financial institution
Telephone number
(optional)
Nine-digit routing transit number
Depositor account number
Type of account
Checking
Savings
General ledger
Signature and title of authorized official
Telephone number
3881
Catalog Number 41140F
Form
(Rev. 4-2016)

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