Will Your Direct Deposit Leave The Us International Ach (Page 3 of 3) in pdf

Will Your Direct Deposit Leave The Us International Ach Page 3

Rensselaer Polytechnic Institute OFAC Compliance Form

International ACH Transaction (IAT)

As a U.S. entity, the University is obligated to comply with the requirements of the United States

Department of Treasury Office of Foreign Assets Control (OFAC), which oversees payments

sent outside the territorial jurisdiction of the United States. This includes automated clearing

house (ACH) payments, such as electronic funds transfer (EFT). Effective September 18, 2009,

the Institute is obligated to identify as an “International ACH Transaction” (IAT) any EFT of a

payment that are (1) made by Rensselaer Polytechnic Institute to a financial institution located

outside the U.S., or (2) made by Rensselaer Polytechnic Institute to a domestic financial

institution if that financial institution immediately transfers the full deposit amount to a financial

institution outside of the US in a “back-to-back” transaction.

If you think you are affected by these new requirements, please fill out the information requested

below.

Yes, I will transfer all of the funds outside the U.S. in a “back-to-back” transaction.

Employee or Student or Vendor Name:__________________________________________

Vendor contact person and title:__________________________________________________

RIN or SSN or TIN:_________________________________________________________

Current Address:___________________________________________________________

Phone Number:_____________________

E-mail Address:_____________________________________ Date completed:_____________

Please Mail, Email, or Fax to:

Payroll

Vendors

Darcey Pickett

Susie Palluti

Payroll Manager

Accounts Payable Manager

Rice Bldg

110 Eight St

Troy, NY 12180

518-276-6926 (phone)

518-276-6923 (phone)

518-276-2151 (fax)

picked2@rpi.edu

pallus@rpi.edu

Will Your Direct Deposit Leave The Us International Ach Page 3