Rd 3550 28 Form PDF Details

In an era where managing finances efficiently and securely is of paramount importance, the RD 3550-28 form emerges as a critical document for those engaging with the United States Department of Agriculture Rural Development programs. This form, officially titled the "Authorization Agreement for Preauthorized Payments," plays a vital role in streamlining the payment process for individuals and organizations by facilitating the electronic collection of payments from their accounts. Endorsed by the Office of Management and Budget under the number 0575-0184, its creation is rooted in the need to comply with the Privacy Act of 1974, alongside various provisions outlined in title 15 U.S.C. 1601, 12 CFR 205, and 31 CFR 202. By providing the essential authority to the Department of Treasury and designated financial institutions, the RD 3550-28 form ensures that payments can be efficiently and securely transferred through the Automated Clearing House System. This meticulously designed process not only serves identification purposes but also guarantees that payments are directed as authorized by the account holders. It's important to recognize the form's mandate that no deductions will be made without a signed authorization, underscoring the safeguarding of account holder's rights. Such measures are indicative of the form's dual objective: facilitating seamless transactions while upholding stringent privacy and security standards. Furthermore, the form accommodates vital information including individual or organization details, loan specific data, and financial institution credentials, all aimed at ensuring that the payment process is executed without discrepancies. By doing so, the RD 3550-28 form embodies a crucial element in the framework of financial transactions within the realm of USDA Rural Development programs, reflecting a balanced approach between operational efficiency and privacy compliance.

QuestionAnswer
Form NameRd 3550 28 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesrd 3550, 3550 28 form, form rd preauthorized form, form rd 3550 28

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USDA

FORM APPROVED

FORM RD 3550-28

OMB NO. 0575-0184

(05-05)

 

AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS

U.S. Department of Agriculture

Rural Development

PAPERWORK REDUCTION ACT AND PRIVACY ACT STATEMENT

The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on the form is required under various provisions of title 15 U.S.C. 1601, 12 CFR 205, and 31 CFR 202, for the purpose of providing authority to the Department of Treasury to designate financial institutions to collect payments, by electronic means, from your account. The information will be used for identification with the records of the government agency and the financial institution to direct your payments to the point you authorize. No deduction may be made unless a signed authorization form is received. Failure to furnish this information may delay or prevent the collection of these payments through the Automated Clearing House System.

 

INDIVIDUAL/COMPANY INFORMATION

 

 

 

 

 

 

 

 

 

 

INDIVIDUAL/ORGANIZATION NAME: (PLEASE PRINT)

 

 

 

 

 

1.

 

 

 

 

 

 

 

STREET ADDRESS:

 

 

 

 

 

BORROWER TELEPHONE NO.

2.

 

 

 

 

 

3.

 

CITY/STATE:

 

 

 

 

 

ZIP CODE:

4.

 

 

 

 

 

5.

 

BORROWER CASE NO.

 

PROJ. NO. (AMAS):

FC/LN :

 

LOAN TYPE :

6.

 

7.

8.

 

 

 

9.

PAYMENT INTERVAL :

START DATE :

 

PAYMENT AMOUNT :

10.

11.

 

 

12.

 

 

 

SERVICING OFFICE CODE:

SERVICING OFFICE TELEPHONE

 

SERVICING OFFICE CONTACT:

 

NO.:

 

 

 

 

 

13.

14.

 

 

15.

 

 

 

I hereby authorize the initiation of a deduction from the account and the financial institution named below to debit such account. I understand I will be notified if the debit amount needs to be adjusted, either to be increased or decreased. I also understand that I have the right to stop automatic payment by notifying my financial institution in writing three days prior to the time my account is charged.

SIGNATURE: 16.DATE: 17.

FINANCIAL INSTITUTION INFORMATION

 

 

 

 

FINANCIAL INSTITUTION NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY/STATE:

 

 

 

 

 

 

 

 

ZIP CODE:

 

 

 

 

20.

 

 

 

 

 

 

 

 

21.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NINE-DIGIT ROUTING TRANSIT NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT TITLE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT NUMBER:

 

 

 

 

CHECKING

 

 

 

 

24.

25.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SAVINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

BANK REPRESENTATIVE SIGNATURE & TITLE

AREA CODE:

 

 

BANK TELEPHONE #:

 

DATE:

26.

27.

 

 

 

 

 

28.

 

 

 

 

 

29.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0184. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

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