Food and Drug Administration
ACH EFT Payment Information Sheet

The Debt Collection Act of 1996 requires all payments by Government Agencies to be made by Electronic Funds Transfer (EFT), via Automated Clearing House (ACH), instead of by check.  If you have any questions, please contact Vendor Control desks:

Allenard Coplin 301-413-0450

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.  The information will be used by the Treasury Department to transmit payment data by electronic means to the vendor's financial institution.  Failure to provide the requested information may delay or prevent the receipt of payment through the Automated Clearing House Payment System.

  Add   Change - Please provide information being changed.

Payee/Company Information

Name:

Mailing Address:

Phone Number:

SSN or TIN (Tax Identification or Fed. ID Number):

Financial Institution Information

Name:
Mailing Address:
Phone Number:
ABA/Routing Transit Number:
(9 digit number)
Bank Account Number:
Account Type:

The Food and Drug Administration is now a participating agency with PAID (Payment Advise Internet Delivery), the Treasury department's remittance information system on the Internet.  Registered vendors can obtain remittance information for payments sent electronically by participating agencies.  To register for PAID, check out the website at: https://fms2.treas.gov/paid/security/paidlogin.asp.

Requestor email: