U.S. Geological Survey Manual

Attachment 4

Company Name
Company Address

Dear Sirs:

The Debt Collection Improvement Act requires most Federal payments to be made electronically beginning January 2, 1999. This Act also requires payments to include the taxpayer identification number (TIN). The TIN is usually an individual's social security number.

We do not have the information checked below to pay your invoice _______________________________ dated__________________.

• ___ Bank account information to make your payment electronically. Please complete the second and third sections of the attached form and return it to the above address as soon as possible. We will schedule your invoice for payment when we receive this information.

• ___ Taxpayer identification number. Please enter your taxpayer identification number on the line below and return it to the above address as soon as possible. We will schedule your invoice for payment when we receive this information.
  Taxpayer Identification Number: ______________________________.

The Debt Collection Improvement Act allows for waivers to the electronic payment requirement in certain instances. If the first box above was checked and you believe you meet the requirements to receive a waiver, please sign the statement below and return this form to the above address.

Payment by electronic funds transfer would impose a hardship due to a physical or mental disability or a geographic, language, or literary barrier, or would impose a financial hardship.

Attachment
1 Payment Enrollment Form
2 Invoice ___________

Return to Instructional Memoranda Page