Ach Payment Enrollment Form PDF Details

The ACH Payment Enrollment Form, officially known as SF 3881 and assigned OMB No. 1510-0056, is issued by the U.S. Department of the Treasury to standardize electronic payments to federal vendors and contractors. It enables the Automated Clearing House (ACH) network to transfer funds directly to a payee's bank account, eliminating paper checks and reducing payment delays.

What Information the Form Requires

The form is divided into three sections, each completed by a different party:

Who Must Submit This Form

Any vendor, contractor, grantee, or individual who receives recurring payments from a U.S. federal agency must submit the ACH Payment Enrollment Form. The Debt Collection Improvement Act of 1996 requires federal agencies to make all eligible payments electronically, making this form mandatory for timely payment receipt.

How Long ACH Enrollment Takes

After the completed form is submitted to the paying federal agency, ACH enrollment is typically processed within one to two payment cycles, ranging from one to four weeks depending on agency processing schedules. Always retain a signed copy for your records.

QuestionAnswer
Form NameAch Payment Enrollment Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesprintable blank ach form, ach wire instructions template, blank printable ach form pdf, how to fill out an ach form

Form Preview Example

ACH VENDOR/MISCELLANEOUS PAYMENT

ENROLLMENT FORM

OMB No. 1510-0056

This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion. See reverse for additional instructions.

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 requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.

AGENCY INFORMATION

FEDERAL PROGRAM AGENCY

AGENCY IDENTIFIER:

AGENCY LOCATION CODE (ALC):

ACH FORMAT:

CCD+

CTX

ADDRESS:

CONTACT PERSON NAME:

ADDITIONAL INFORMATION:

TELEPHONE NUMBER:

()

PAYEE/COMPANY INFORMATION

NAME

ADDRESS

CONTACT PERSON NAME:

SSN NO. OR TAXPAYER ID NO.

TELEPHONE NUMBER:

()

FINANCIAL INSTITUTION INFORMATION

NAME:

ADDRESS:

ACH COORDINATOR NAME:

TELEPHONE NUMBER:

 

 

 

 

 

 

 

(

)

NINE-DIGIT ROUTING TRANSIT NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPOSITOR ACCOUNT TITLE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPOSITOR ACCOUNT NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCKBOX NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE OF ACCOUNT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECKING

 

SAVINGS

 

 

 

 

LOCKBOX

 

 

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER:

(Could be the same as ACH Coordinator)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

AUTHORIZED FOR LOCAL REPRODUCTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SF 3881 (Rev. 2/2003 )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prescribed by Department of Treasury

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31 U S C 3322; 31 CFR 210

Instructions for Completing SF 3881 Form

Make three copies of form after completing. Copy 1 is the Agency Copy; copy 2 is the Payee/Company Copy; and copy 3 is the Financial Institution Copy.

1.Agency Information Section - Federal agency prints or types the name and address of the Federal program agency originating the vendor/miscellaneous payment, agency identifier, agency location code, contact person name and telephone number of the agency. Also, the appropriate box for ACH format is checked.

2.Payee/Company Information Section - Payee prints or types the name of the payee/company and address that will receive ACH vendor/miscellaneous payments, social security or taxpayer ID number, and contact person name and telephone number of the payee/company. Payee also verifies depositor account number, account title, and type of account entered by your financial institution in the Financial Institution Information Section.

3.Financial Institution Information Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included.

Burden Estimate Statement

The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD 20782 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503.

How to Edit Ach Payment Enrollment Form Online for Free

Filling out the ACH Payment Enrollment Form online is straightforward using the FormsPal PDF editor. Follow these steps to complete and save the form right in your browser.

Step 1: Click the orange "Get Form Now" button to open the ACH Payment Enrollment Form in the online editor.

Step 2: Complete each of the three sections. In the payee section, enter your legal name, Taxpayer Identification Number, mailing address, and ACH coordinator contact. Your bank representative fills out the financial institution section with your nine-digit routing transit number, account title, account number, and account type.

Type your information directly into the fields, check boxes, insert a signature, and mark any sections that do not apply to your situation.

entering details in blank printable ach form pdf part 1

Fill in the ADDRESS, ACH COORDINATOR NAME, NINE-DIGIT ROUTING TRANSIT NUMBER, DEPOSITOR ACCOUNT TITLE, DEPOSITOR ACCOUNT NUMBER, TYPE OF ACCOUNT, TELEPHONE NUMBER, LOCKBOX NUMBER, and SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL fields as required by the paying agency.

Finishing blank printable ach form pdf part 2

Step 3: Click the "Done" button to finalize your form. You can then download the PDF to your device, print it, or email it directly to the federal agency requesting payment enrollment.

Step 4: Save at least two copies of the completed and signed form. Provide the original to the paying federal agency and retain one copy for your financial records in case of payment delays or disputes.

Related ACH and Direct Deposit Forms

Depending on your payment scenario, you may also need one of these related forms:

Frequently Asked Questions About the ACH Payment Enrollment Form

What is the difference between the ACH Payment Enrollment Form and an ACH authorization form?
The ACH Payment Enrollment Form (SF 3881) is used specifically for federal government payments to vendors and contractors. A standard ACH authorization form is used in the private sector to authorize businesses to electronically debit or credit a bank account.

Do I need to submit a new form when I change banks?
Any time your routing number, account number, account type, or financial institution changes, you must complete and submit a new ACH Payment Enrollment Form to the paying federal agency.

Where do I send the completed ACH Payment Enrollment Form?
Return the form directly to the federal agency making payments to you, not to the U.S. Treasury. Each agency has its own submission process, so contact your agency representative for instructions.

Can I use this form for state government payments?
No. The SF 3881 ACH Payment Enrollment Form applies only to U.S. federal government payments. State agencies use their own direct deposit enrollment forms specific to each state's payment system.

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