# Instructions for Completing SF 3881 Form

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. Payee
    prints or types the Grant Number.

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, 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 record keeper, 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.
>
> ACH VENDOR/MISCELLANEOUS PAYMENT OMB No. 1510-0056

ENROLLMENT FORM Expiration Date 06/30/93

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.

+---------------+--------------------------+-------+---+--------------+
| **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        |                          |       |   |              |
|               |                          |       |   |              |
| National Park |                          |       |   |              |
| Service       |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| AGENCY        | AGENCY LOCATION CODE     | ACH   |   |              |
| IDENTIFIER:   | (ALC):                   | FO    |   |              |
|               |                          | RMAT: |   |              |
| NPS           |                          |       |   |              |
|               |                          | CCD+  |   |              |
|               |                          | CTX   |   |              |
|               |                          | CTP   |   |              |
+---------------+--------------------------+-------+---+--------------+
| ADDRESS:      |                          |       |   |              |
|               |                          |       |   |              |
| 1849 C        |                          |       |   |              |
| Street, NW    |                          |       |   |              |
| (2255)        |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| Washington,   |                          |       |   |              |
| D.C. 20240    |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| CONTRACT      |                          |       | T |              |
| PERSON NAME:  |                          |       | E |              |
|               |                          |       | L |              |
| Kristen       |                          |       | E |              |
| Stevens       |                          |       | P |              |
|               |                          |       | H |              |
|               |                          |       | O |              |
|               |                          |       | N |              |
|               |                          |       | E |              |
|               |                          |       | N |              |
|               |                          |       | U |              |
|               |                          |       | M |              |
|               |                          |       | B |              |
|               |                          |       | E |              |
|               |                          |       | R |              |
|               |                          |       |   |              |
|               |                          |       | \ |              |
|               |                          |       | ( |              |
|               |                          |       | 2 |              |
|               |                          |       | 0 |              |
|               |                          |       | 2 |              |
|               |                          |       | \ |              |
|               |                          |       | ) |              |
|               |                          |       | 3 |              |
|               |                          |       | 5 |              |
|               |                          |       | 4 |              |
|               |                          |       | - |              |
|               |                          |       | 2 |              |
|               |                          |       | 0 |              |
|               |                          |       | 3 |              |
|               |                          |       | 7 |              |
+---------------+--------------------------+-------+---+--------------+
| ADDITIONAL    |                          |       |   |              |
| INFORMATION   |                          |       |   |              |
|               |                          |       |   |              |
| Grant Number: |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
|               |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| **            |                          |       |   |              |
| PAYEE/COMPANY |                          |       |   |              |
| INFORMATION** |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| NAME          |                          |       | S |              |
|               |                          |       | S |              |
|               |                          |       | N |              |
|               |                          |       | N |              |
|               |                          |       | O |              |
|               |                          |       | . |              |
|               |                          |       | O |              |
|               |                          |       | R |              |
|               |                          |       | T |              |
|               |                          |       | A |              |
|               |                          |       | X |              |
|               |                          |       | P |              |
|               |                          |       | A |              |
|               |                          |       | Y |              |
|               |                          |       | E |              |
|               |                          |       | R |              |
|               |                          |       | I |              |
|               |                          |       | D |              |
|               |                          |       | N |              |
|               |                          |       | O |              |
|               |                          |       | . |              |
+---------------+--------------------------+-------+---+--------------+
| ADDRESS       |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
|               |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| CONTACT       |                          |       | T |              |
| PERSON NAME:  |                          |       | E |              |
|               |                          |       | L |              |
|               |                          |       | E |              |
|               |                          |       | P |              |
|               |                          |       | H |              |
|               |                          |       | O |              |
|               |                          |       | N |              |
|               |                          |       | E |              |
|               |                          |       | N |              |
|               |                          |       | U |              |
|               |                          |       | M |              |
|               |                          |       | B |              |
|               |                          |       | E |              |
|               |                          |       | R |              |
|               |                          |       | : |              |
|               |                          |       |   |              |
|               |                          |       | ( |              |
|               |                          |       | ) |              |
+---------------+--------------------------+-------+---+--------------+
|               |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| **FINANCIAL   |                          |       |   |              |
| INSTITUTION   |                          |       |   |              |
| INFORMATION** |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| NAME:         |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| ADDRESS:      |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
|               |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| ACH           |                          |       | T |              |
| COORDINATOR   |                          |       | E |              |
| NAME:         |                          |       | L |              |
|               |                          |       | E |              |
|               |                          |       | P |              |
|               |                          |       | H |              |
|               |                          |       | O |              |
|               |                          |       | N |              |
|               |                          |       | E |              |
|               |                          |       | N |              |
|               |                          |       | U |              |
|               |                          |       | M |              |
|               |                          |       | B |              |
|               |                          |       | E |              |
|               |                          |       | R |              |
|               |                          |       | : |              |
|               |                          |       |   |              |
|               |                          |       | ( |              |
|               |                          |       | ) |              |
+---------------+--------------------------+-------+---+--------------+
| NINE-DIGIT    |                          |       |   |              |
| ROUTING       |                          |       |   |              |
| TRANSIT       |                          |       |   |              |
| NUMBER:       |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| DEPOSITOR     |                          |       |   |              |
| ACCOUNT       |                          |       |   |              |
| TITLE:        |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| DEPOSITOR     |                          |       |   | LOCKBOX      |
| ACCOUNT       |                          |       |   | NUMBER:      |
| NUMBER:       |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| TYPE OF       |                          |       |   |              |
| ACCOUNT:      |                          |       |   |              |
|               |                          |       |   |              |
| CHECKING      |                          |       |   |              |
| SAVINGS       |                          |       |   |              |
| LOCKBOX       |                          |       |   |              |
+---------------+--------------------------+-------+---+--------------+
| **SIGNATURE   |                          |       | T |              |
| AND TITLE OF  |                          |       | E |              |
| AUTHORIZED    |                          |       | L |              |
| OFFICIAL:**   |                          |       | E |              |
|               |                          |       | P |              |
| (Could be the |                          |       | H |              |
| same as ACH   |                          |       | O |              |
| Coordinator)  |                          |       | N |              |
|               |                          |       | E |              |
|               |                          |       | N |              |
|               |                          |       | U |              |
|               |                          |       | M |              |
|               |                          |       | B |              |
|               |                          |       | E |              |
|               |                          |       | R |              |
|               |                          |       | : |              |
|               |                          |       |   |              |
|               |                          |       | ( |              |
|               |                          |       | ) |              |
+---------------+--------------------------+-------+---+--------------+

SF 3881 (Rev. 12/90)

NSN 7540-01-274-9925 3881-102 Prescribed by Department of Treasury

31 U.S.C. 3322; 31 CFR 210