ACH VENDOR/MISCELLANEOUS PAYMENT 

ENROLLMENT FORM

OMB No. 1510-0056

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. See reverse for additional instructions.

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.

PRIVACY ACT STATEMENT

AGENCY INFORMATION

FEDERAL PROGRAM AGENCY

AGENCY IDENTIFIER: AGENCY LOCATION CODE (ALC): ACH FORMAT:

CCD+ CTX

ADDRESS:

CONTACT PERSON NAME: TELEPHONE NUMBER:

( )

ADDITIONAL INFORMATION:

PAYEE/COMPANY INFORMATION

NAME

ADDRESS

CONTACT PERSON NAME: TELEPHONE NUMBER:

( )

SSN NO. OR TAXPAYER ID NO.

FINANCIAL INSTITUTION INFORMATION

NAME:

ADDRESS:

ACH COORDINATOR NAME: TELEPHONE NUMBER:

NINE-DIGIT ROUTING TRANSIT NUMBER:

DEPOSITOR ACCOUNT TITLE:

DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER:

TYPE OF ACCOUNT:

CHECKING SAVINGS LOCKBOX

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: 

(Could be the same as ACH Coordinator)

TELEPHONE NUMBER:

( )

( )

SF 3881 (Rev. 2/2003 ) 

Prescribed by Department of Treasury 

31 U S C 3322; 31 CFR 210

AUTHORIZED FOR LOCAL REPRODUCTION
Instructions for Completing SF 3881 Form

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. Also, the 

appropriate box for ACH format is checked.

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, and 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.

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.

1.

2.

3.

Burden Estimate Statement

The estimated average burden associated with this collection of information is 15 minutes per 

respondent or recordkeeper, 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.

Make three copies of form after completing. Copy 1 is the Agency Copy; copy 2 is the Payee/

Company Copy; and copy 3 is the Financial Institution Copy.