NATIONAL INTERAGENCY FIRE CENTER

CASUAL PAYMENT CENTER

3833 S DEVELOPMENT AVE, BOISE, ID 83705-5354 

EMAIL: CASUALPAY@BLM.GOV

PHONE: 877-471-2262 FAX: 208-433-6405 

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Electronic Funds Transfer (EFT) Waiver Request

Check one: BIA BLM FWS NPS

NAME: SSN: 

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As of March 1, 2013, all Federal payments must be processed electronically. The Treasury Department will discontinue 

issuing paper checks unless a valid waiver is in place. 

According to 31 CFR Part 208.4 you may apply for a waiver if either of the following conditions exists (please indicate 

which condition applies to you by checking the appropriate box. You may check more than one):

A) “Electronic funds transfer would impose a hardship because of the individual's inability to manage an account 

at a financial institution due to a mental impairment,” or

B) “Electronic funds transfer would impose a hardship because of the individual's inability to manage an account 

at a financial institution due to the individual living in a remote geographic location lacking the infrastructure to 

support electronic financial transactions.” 

This waiver will remain in effect for the current calendar year only. Any payments will be sent by paper check to the 

current mailing address on file. If any changes are needed to your mailing address, complete and send in a W-4 or Address 

Change Form. 

The U.S. Department of Treasury also provides information on how to obtain low-cost Electronic Funds Transfer 

(EFT) Accounts that can be opened at a participating bank, savings and loan, or credit union. If you use this option, 

all payments will be sent to your EFT Account, and an EFT Waiver Request will not be required in future years. To 

find out how you can open an EFT Account visit their website at https://www.fiscal.treasury.gov/eft/. 

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By signing, I attest that I am the person named above and that I have read and understand the information 

presented. I am requesting a waiver to keep my federal payment from being deposited electronically. I understand 

that all payments will be made by paper check and that in the event the check is lost, stolen, mutilated, or forged it 

may take up to six weeks or more to trace the check.

SIGNATURE: DATE: PHONE #: 

Privacy Act Statement: Information on this form is collected under the authority of the Administratively Determined (AD) Pay Plan. Information collected via this form is covered by the Privacy Act of 1974 and Privacy 

Act System of Records Notice DOI-85. The primary use of this information is to start, stop, or change entitlements and to process any voluntary or involuntary deductions on pay and leave issues. The information you 

furnish will be used to identify records properly associated with you, to obtain additional information to update your record, if necessary, and to determine any present or future entitlement. Disclosure may be made 

only to authorized persons according to Title 5 USC 552a and for uses described in System of Records Notices DOI-85. Submission of the information in this form is voluntary; however, requests will not be completed 

without the information needed to process the request. 

Revised 01/2022