Form 3624 Usps Details

Usps Form 3624 is a required form to be completed when filing a claim for insurance reimbursement with the United States Postal Service. The form can be downloaded from the USPS website and must be filled out in full before submitting it to the appropriate postal service center. Completed forms should be submitted as soon as possible after an incident occurs in order to expedite the reimbursement process. A list of required documentation can also be found on the USPS website and should be included with your submission. For more information, visit the official USPS website at www.usps.com. You can also download a copy of Usps Form 3624 here: www.uspsform3624.com.

Below is the data concerning the form you were looking for to complete. It can tell you the length of time you'll need to complete usps form 3624, what parts you need to fill in and a few additional specific details.

QuestionAnswer
Form NameUsps Form 3624
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesnon profit application usps, ps form 3624, usps nonprofit bulk mail form, bulk mail application usps form

Form Preview Example

Application to Mail at

Nonprofit Standard Mail Prices

Application Number:

Section A - Application (Please read section B on page 2 before completion.)

Part 1 (For completion by applicant)

All information entered below must be legible so that our records will show the correct information about your organization.

The complete name of the organization must be shown in item 1. The name shown must agree with the name that appears on all documents submitted to support this application.

A complete address representing a physical location for the organization must be shown in item 2. If you receive mail through a Post Office™ box, show your street address first and use alternate address for the box.

The applicant named in item 7 must be the individual submitting the application for the organization and must be a responsible official of the organization. Printers and mailing agents may not sign for the organization.

No additional organization categories may be added in item 9. To be eligible for the Nonprofit Standard Mail prices, the organization must qualify as one of the types listed.

The applicant must sign the application in item 15.

The application must be submitted to the Post Office in item 14 and on the date shown in item 17.

No application fee is required. (All information must be complete and typewritten or printed legibly.)

1.Complete Name of Organization (If voting registration official, include title)

2.

Street Address of Organization (Include apartment or suite number)

3.

City, State, ZIP+4® Code

 

 

 

 

4.

Alternate Mailing Address

5.

Alternate City, State, ZIP+4® Code

 

6.Telephone (Include area code)

7.Name of Applicant (Must represent applying organization)

8. Email Address

9. Type of Organization (Check only one)

(01) Religious

 

(03) Scientific

(05) Agricultural

(07) Veterans

(09)Qualified political committee (Go to item 12)

(02) Educational

(04) Philanthropic

(06) Labor

(08) Fraternal

(10)Voting registration official (Go to item 12)

Not all nonprofit organizations are eligible for the Nonprofit Standard Mail prices. Domestic Mail Manual® 703.1 lists certain organizations (such as business leagues, chambers of commerce, civic improvement associations, social and hobby clubs, governmental bodies, and others) that, although nonprofit, do not qualify for the Nonprofit Standard Mail prices.

10. Is this a for-profit organization or does any of the net income

 

 

Yes

12.

Has this organization previously mailed at the Nonprofit

 

Yes

 

 

 

 

inure to the benefit of any private stockholder or individual?

 

 

 

 

Standard Mail prices? (If `Yes,’ list the Post Office locations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

where mailings were most recently deposited at these prices

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

and provide the nonprofit authorization number, if known.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Is this organization exempt from federal income tax? (If

 

Yes

 

 

 

 

 

 

 

 

 

 

 

‘Yes,’ attach a copy of the exemption issued by the Internal

 

 

 

 

 

 

 

 

 

 

 

 

 

Revenue Service (IRS) that shows the section of the IRS

 

No

 

 

 

 

 

 

 

 

 

 

 

code under which the organization is exempt. Required if

 

 

 

 

 

 

 

 

13.

Has your organization had Nonprofit Standard Mail privileges

 

 

 

exempt. Do not submit State tax exemption information.)

 

Yes

 

 

Yes

Has the IRS denied or revoked the organization’s federal tax

 

 

denied or revoked? (If `Yes,’ list the Post Office (city and

 

 

 

 

 

state) where the application was denied or authorization was

 

 

 

exempt status? (If `Yes,’ attach a copy of the IRS ruling

 

No

 

revoked and provide the nonprofit authorization number, if

 

 

No

to this PS Form 3624.)

 

 

 

 

 

known.)

 

 

 

 

 

 

 

 

 

 

 

From your IRS exemption letter, check off the box corresponding

 

 

 

 

 

 

to the section under which the organization is exempt:

 

 

 

 

 

 

501(c)(3)

501(c)(5)

 

14. Post Office (not a station or branch) where authorization

 

 

501(c)(8)

501(c)(19)

 

 

 

 

 

requested and bulk mailings will be made (City, state, ZIP

 

 

Other 501(c) (

) (See statement in item 9 above)

 

 

Code™).

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that the statements made by me are true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including multiple damages and civil penalties). I further understand that, if this application is approved, a postage refund for the difference between the regular Standard Mail and Nonprofit Standard Mail prices may be made for only mailings entered at regular Standard Mail prices at the Post Office identified above while this application is pending, provided that the conditions set forth in Domestic Mail Manual 703.1 and 703.1.9 are met.

15. Signature of Applicant

Part 2 (For completion by postmaster at originating office when application filed)

16. Title

17. Date

1.Signature of Postmaster (Or designated representative)

2. Date Application Filed With Post Office (Round stamp)

PS Form 3624, April 2012 (Page 1 of 3) PSN 7530-02-000-9014

PRIVACY NOTICE: See our privacy policy on www.usps.com

Section B—General Information

Organization Eligibility

The Nonprofit Standard Mail prices may be granted only to:

1.The eight categories (01 through 08) of nonprofit organizations specified on page 1 in section A, item 9.

2.Qualified political committees (category 09), including the national and state committees of political parties as well as certain named congressional committees.

3.Voting registration officials (category 10), including local, state, and District of Columbia voting registration officials.

These organizations are defined in Domestic Mail Manual (DMM®) 703.1, available for review at pe.usps.com.

To qualify, a nonprofit organization must be both organized and operated for a primary purpose that is consistent with one of the types of organizations in DMM 703.1. Organizations that incidentally engage in qualifying activities do not qualify for the Nonprofit Standard Mail prices.

Application Procedures

1.Only organizations may apply. Individuals may not apply (except voting registration officials).

2.Only the one category in item 9 that best describes the primary purpose of the organization may be checked.

3.The application must be signed by someone in authority in the organization, such as the president or treasurer. It must not be signed by a printer or mailing agent.

4.The completed PS Form 3624 must be submitted to the Post Office where Nonprofit Standard Mail mailings will be deposited. If the application is approved, the authorization will apply nationwide. Use PS Form 3623 Request for Confirmation of Authorization (or Pending Application) to Mail at Nonprofit Standard Mail Prices to deposit at a Post Office location that does participate in PostalOne!.

Supporting Documentation

The documents listed in 1 and 2 below must be submitted with the completed applications for nonprofit organizations. The documents listed in 3 must be submitted for qualified political committees and, in 4, for voting registration officials.

1.Evidence that the organization is nonprofit and that none of its net income inures to the benefit of any private stockholder or individual. Acceptable evidence includes:

An Internal Revenue Service (IRS) letter of exemption from payment of federal income tax.

If an IRS exemption letter is not available, a complete financial statement from an independent auditor (such as a certified public accountant) substantiating that the organization is nonprofit. A statement from a member of the organization is not sufficient. (Do not submit State tax exemption information.)

2.Documents describing the organization’s primary purpose, such as:

Organizing instruments that state the purpose for which the group is organized, such as the constitution, articles of incorporation, articles of association, or trust indenture. The organizing instrument, including all amendments to the original, should bear the seal, certification, or signature of the Secretary of State or other appropriate state official. If one or more of these documents are not sealed, certified, or signed by state officials, an officer or other person authorized to sign for the applicant should submit a written declaration certifying that the documents are complete and accurate copies of the originals.

Materials showing how the organization actually operated during the previous 6 to 12 months and how it will operate in the future. Bulletins, financial statements, membership forms, publications produced by the organization, minutes of meetings, or a list of its activities may be used.

3.For qualified political committees (category 09), organizational or other documents substantiating that the applicant is the state or national committee of the political party.

4.For voting registration officials (category 10), a copy of the statute, ordinance, or other authority establishing responsibility for voter registration.

Mail Eligibility

An organization authorized to mail at the Nonprofit Standard Mail prices may mail only its own matter at those prices. It may not delegate or lend the use of its Nonprofit Standard Mail authorization to any other person or organization. Cooperative mailings may be made at the Nonprofit Standard Mail prices only if each of the cooperating organizations is individually authorized to mail at those prices.

DMM 703.1 discusses the specific restrictions against the mailing of certain advertising materials and products.

PS Form 3624, April 2012 (Page 2 of 3)

Postal Service™ Checklist for PS Form 3624,

Application to Mail at Nonprofit Standard Mail Prices

Name of Organization

The organization above provided the following evidence of eligibility for Nonprofit Standard Mail prices.

1.Nonprofit Status (Select at least one)

IRS letter of exemption from payment of federal income tax

Financial statement prepared by an independent auditor substantiating organization’s nonprofit status (statement must include balance sheets, notes, etc.)

Place of Worship

2.Organization (One complete copy; check all that apply. Must select at least one.)

Articles of Incorporation

 

Articles of Association

 

Charter

 

Constitution

Enabling Legislation

 

Trust Indenture

 

Other (Explain):

 

 

 

 

 

 

3.Operation (Several samples of each; check types of information included with application)

Bulletins

 

Brochures

 

Financial statements

 

Listing of activities for past 6 to

 

 

 

 

 

 

12 months

 

 

 

 

 

 

 

 

 

 

 

Membership applications

 

Minutes of meetings

 

Newsletters

 

Organizational or other documents substantiating that the applicant is the state or national committee of the political party

A copy of the statute, ordinance or other authority establishing responsibility for voter registration

Other (Explain):

The name on all the documents presented as evidence must match the name on the application. If they do not match, please explain.

Postmaster: PostalOne! offices must enter the information from the application into the PostalOne! system.

Non-PostalOne! offices must mail the application and documentation to the Pricing and Classification Service Center.

I certify that the applicant has completed all the items on the application and that each item is legible.

Signature of Postmaster (Or designated representative)

Date

 

 

 

 

Telephone (Include area code)

Post Office (City, state, ZIP Code™)

 

 

 

Date Application Returned to Organization for Correction

Date Application and Documentation Sent to Pricing and Classification

 

Service Center

 

 

 

PS Form 3624, April 2012 (Page 3 of 3) PSN 7530-02-000-9014

PRIVACY NOTICE: See our privacy policy on www.usps.com