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__________________.
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.
1 Payment Enrollment Form
2 Invoice ___________
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