Form 109a Instructions - Suspicious Activity Report By Money Services Business printable pdf download

FinCEN Form 109a

Suspicious Activity Report by Money Services Business -- Instructions

Safe Harbor

instruments involved are redeemed for monetary

or evade any Federal law or regulation or to avoid

value — that is, for currency or monetary or other

any transaction reporting requirement under

Federal law (31 U.S.C. 5318(g)(3)) provides

negotiable or other instruments. The taking of the

Federal law or regulation;

complete protection from civil liability for all

instruments in exchange for goods or general ser-

reports of suspicious transactions made to

vices is not redemption under BSA regulations.

ii. The transaction is designed, whether

appropriate authorities, including supporting

through structuring or other means, to evade any

documentation, regardless of whether such

C. General Instructions

regulations promulgated under the Bank Secrecy

reports are filed pursuant to this report’s

Act; or

instructions or are filed on a voluntary basis.

1. This form should be e-filed through the

Specifically, the law provides that a financial

Bank Secrecy Act E-filing System. Go to

iii. The transaction has no business or

institution, and its directors, officers, employees

to register. This

apparent lawful purpose and the money services

and agents, that make a disclosure of any possible

form is also available for download on the Finan-

business knows of no reasonable explanation for

violation of law or regulation, including in

cial Crimes Enforcement Network’s Web site at

the transaction after examining the available facts,

connection with the preparation of suspicious

, or may be ordered by calling the

including the background and possible purpose

activity reports, “shall not be liable to any person

IRS Forms Distribution Center at (800) 829-3676.

of the transaction.

under any law or regulation of the United States,

any constitution, law, or regulation of any State or

If not filed electronically, send each

iv. The transaction involves the use of the

political subdivision of any State, or under any

completed suspicious activity report to:

money services business to facilitate criminal

contract or other legally enforceable agreement

activity.

(including any arbitration agreement), for such

Enterprise Computing Center-Detroit

disclosure or for any failure to provide notice of

b. To the extent that the identification of

ATTN: SAR-MSB

such disclosure to the person who is the subject

transactions required to be reported is derived

P.O. Box 33117

of such disclosure or any other person identified

Detroit, MI 48232-5980

from a review of clearance records or other similar

in the disclosure”.

records of money orders or traveler’s checks that

3. While all items should be completed fully

have been sold or processed, an issuer of money

Notification Prohibited

orders or traveler’s checks shall only be required

and accurately, items marked with an asterisk (*)

to report a transaction or a pattern of transactions

must be completed according to the provisions of

Federal law (31 U.S.C. 5318(g)(2)) provides that

that involves or aggregates funds or other assets

paragraph 4 below.

a financial institution, and its directors, officers,

of at least $5,000.

employees, and agents, who report suspicious

4. If the information for a data item marked

transactions to the government voluntarily or as

2. File a SAR-MSB no later than 30 calendar

with a asterisk (*) is not known or not appli-

required by 31 CFR 103.20, may not notify any

days after the date of initial detection of facts that

cable, enter special response “XX” (Exception:

person involved in the transaction that the

constitute a basis for filing the report.

Items 11, 20, 21, and 34 - see instructions in

transaction has been reported.

Section D) NOTE: Check boxes are not data

3. The Bank Secrecy Act requires that each

items. To indicate “Total amount” as unknown,

Notification Required

financial institution (including a money services

check the box provided. Non-asterisk fields

business) file currency transaction reports (CTRs)

should be left blank if the information is

In situations involving suspicious transactions

in accordance with the Department of the Treasury

unknown or not applicable.

requiring immediate attention, such as ongoing

implementing regulations (31 CFR Part 103). These

money laundering schemes, a money transmitter;

regulations require a financial institution to file a

5. Complete each suspicious activity report by

a currency dealer or exchanger; or an issuer,

CTR (FinCEN Form 104) whenever a currency

providing as much information as possible on

seller, or redeemer of money orders and/or

transaction exceeds $10,000. If a currency

initial and amended or corrected reports.

traveler’s checks shall immediately notify, by

transaction exceeds $10,000 and is suspicious, a

telephone, an appropriate law enforcement

money transmitter, or issuer, seller or redeemer

6. Do not include supporting documents when

authority. In addition, a timely SAR-MSB form

of money orders and/or traveler’s checks or

filing the suspicious activity report . Retain a copy

shall be filed, including recording any such

currency dealer or exchanger must file two forms,

of the suspicious activity report and all supporting

notification in Part VI on the form.

a CTR to report the currency transaction and a

documentation or business record equivalent in

SAR-MSB to report the suspicious aspects of the

your files for five (5) years from the date of the

A. When To File A Report:

transaction. If the suspicious activity involves a

report. All supporting documentation (such as

currency transaction that is $10,000 or less, the

copies of instruments; receipts; sale, transaction

1. Money transmitters; currency dealers and

institution is only required to file a SAR-MSB.

or clearing records; photographs, surveillance

exchangers; and issuers, sellers and redeemers

Appropriate records must be maintained in each

audio and/or video recording medium) must be

of money orders and/or traveler’s checks that are

case. See 31 CFR Part 103

made available to appropriate authorities upon

subject to the requirements of the Bank Secrecy

request.

Act and its implementing regulations (31 CFR Part

B. Abbreviations and Definitions

103) are required to file a suspicious activity report

7. Type or complete the report using block

(SAR-MSB) with respect to:

1. EIN -- Employer Identification Number

written letters.

2. IRS -- Internal Revenue Service

a. Any transaction conducted or attempted

3. ITIN -- Individual Taxpayer Identification

8. If more than one subject is being reported,

by, at, or through a money services business

Number

use as many copies of the Part I Subject Information

involving or aggregating funds or other assets of

4. SSN -- Social Security Number

page as necessary to record the additional subjects.

at least $2,000 (except as described in section

5. Instruments -- includes Money order(s)

Attach the additional page(s) behind page 1. If

“b” below) when the money services business

and/or Traveler’s Check(s)

more than one transaction location is being

knows, suspects, or has reason to suspect that:

reported, use as many copies of the Part III

6. Redeemer

--A business that accepts

Transaction Location Information page as necessary

i. The transaction involves funds derived

instruments in exchange for currency or other

to record the additional locations. Attach the

from illegal activity or is intended or conducted

instruments for which it is not the issuer is a

additional page(s) behind page 2. If more space

in order to hide or disguise funds or assets derived

redeemer. The MSB definition in 31 CFR

is needed for the Part VI Narrative, add as many

from illegal activity (including, without limitation,

103.11(u)(4) extends to “redeemers” of money

blank continuation pages as necessary to complete

the nature, source, location, ownership or control

orders and traveler’s checks only insofar as the

the narrative. Attach the additional pages behind

of such funds or assets) as part of a plan to violate

page 3.

(Rev. 10/08)

Catalog No. 49341U

Form 109a Instructions - Suspicious Activity Report By Money Services Business

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