Form TTB F 5000.31 TTB F 5000.31 Pay.gov User Agreement

OMB No. 1513-0117 (07/31/2010)
EFFECTIVE DATE

DEPARTMENT OF THE TREASURY
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB)

Pay.gov User Agreement
The following constitutes the full understanding and agreement between the Alcohol and Tobacco Tax and Trade Bureau (TTB) and
(a person from a User Company that deals with the Alcohol and Tobacco Tax and Trade Bureau) with
regard to the Pay.gov system. This system is subject to the following conditions.
1. User Account(s) and Access: Upon receipt of an approved
agreement, the system administrator will provide a unique username
to the user via email. The system administrator also will contact the
user via telephone with a password that the user will be required to
reset upon his/her first access of the system. With respect to the
username, the following conditions apply:
a. The user is solely responsible for the security and proper use of
his/her username and password and must take all necessary
steps to ensure the password is kept confidential and secure, is
used properly, and is not disclosed to anyone.
b. The user and the stated User Company agree to indemnify and
hold harmless and hereby waive all potential claims for damages
against the Department of Treasury and its constituent units
arising from any conduct by the user, the stated User Company,
and its employees or agents that results in or constitutes a breach
of password security or unauthorized use of the Pay.gov system.
c. The user and the user company agree to request revocation of
the Pay.gov user ID when the user no longer has Signature
Authority or Power of Attorney for the User Company.
d. If the user or system administrator identifies that the password
security has potentially been breached, they will inform each other
and the system administrator will reset the password for that
account and provide the new password to the user via telephone
before the next tax payment due date.
e. The user agrees he/she will use the system solely for submitting
information for the stated User Company.
f.

Regardless of whether the user and the User Company have
actual control over the acts of third parties, they agree that they
have the last clear chance to avoid breach of password security
for the username and agree to indemnify and hold TTB harmless
for any such breach.

2. Network Connection(s): The user agrees that he/she will be
responsible for providing, maintaining, and supporting a connection to
the Pay.gov system via the Internet. The system administrator will be
responsible for providing, maintaining, and supporting the Pay.gov
system and its connection to the Internet.
3. System Monitoring: The user and the User Company acknowledge
that the Pay.gov system is a government computer system and
consents to monitoring of the system for security, system
maintenance, tax administration, law enforcement, and any other
purpose authorized by law.
4. System Outage: In the event that the user cannot access the
Pay.gov system, he/she will immediately notify the system
administrator to report the problem. The user and the User Company
also acknowledge they still are expected to submit payments when
due even if the Pay.gov system is not available.
5. Electronic payment of taxes due: The user and the User Company
consent to the use of Automated Electronic Payments from the bank

account(s) specified in the Pay.gov system for the amount(s)
calculated by Pay.gov from the data entered.
6. Confidentiality of returns and return information: Section 6103,
Title 26, United States Code prohibits the disclosure of tax
return(s) or return information (as defined in Section 6103) except
in specifically proscribed circumstances and provides civil and
criminal penalties for the unlawful disclosure of such information.
However, Section 6103 (c) permits the disclosure of return
information to a designee of the taxpayer upon the taxpayer’s
request. The user and the User Company consent that this
Agreement constitutes a request for disclosure to the User
Company’s designee(s) under Section 6103 (c). Further, the
User Company agrees that accessing the Pay.gov system by
means of the assigned username constitutes an affirmative
waiver of all claims under Section 6103, Title 26 United States
Code with respect to any return information transmitted during the
online access session.
7. Penalties and interest: TTB agrees to waive penalties assessed
due to failure to timely pay taxes due, where a system failure or
downtime caused the delay in submission and the delay or failure
to pay is not caused by error or negligence of the User Company.
This limited waiver applies only to penalties for failure to pay
(Section 6651 (a) (2), Title 26 United States Code), or failure to
deposit (Section 6656, Title 26 United States Code), when it has
been reasonably demonstrated by the User Company, to the
satisfaction of TTB, that the failure to pay was caused by the
downtime or failure of the Pay.gov system and not by actions of
the User Company. Notwithstanding the above, the User
Company understands and acknowledges that TTB lacks any
legal authority to waive or compromise interest due on late or
insufficient tax payments.
8. Termination of Agreement: TTB, the user, and the User
Company agree that this User Agreement applies only to the
Pay.gov system. Periodic enhancements, improvements, and
changes to the Pay.gov system will not impact this agreement.
Further, the user, the User Company, and TTB agree that this
agreement may be terminated at any time for any reason upon
written notice.
9. Separation of conditions: If any provision of this Agreement is
held to be invalid or unenforceable for any reason whatsoever,
the remaining provisions will remain valid and unimpaired, and
will continue in full force and effect.
10. Agreement: This agreement supersedes any and all other
agreements, whether oral or written, between TTB, the user, and
the User Company with respect to the matters stated herein, and
this agreement contains all of the covenants and agreements
between the parties with respect thereto. This agreement may be
amended or modified only in writing and will be effective only
after affixation of the signatures of both parties’ representatives.

USER INFORMATION:
NAME

SIGNATURE

TITLE

DATE

E-MAIL ADDRESS

TELEPHONE NUMBER

For Alcohol and Tobacco Companies:
I HAVE:
S IGNATURE A UTHORITY

P OWER O F A TTORNEY TO SUBMIT E XCISE T AX

BLANKET POWER O F ATTORNEY

POWER OF ATTORNEY TO SUBMIT OPERATIONAL REPORTS

TTB F 5000.31 (09/2007)

COMPANY NAME

COMPANY NAME

TAXPAYER IDENTIFICATION NUMBER

TAXPAYER IDENTIFICATION NUMBER

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

COMPANY NAME

COMPANY NAME

TAXPAYER IDENTIFICATION NUMBER

TAXPAYER IDENTIFICATION NUMBER

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

COMPANY NAME

COMPANY NAME

TAXPAYER IDENTIFICATION NUMBER

TAXPAYER IDENTIFICATION NUMBER

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

PERMIT / REGISTRY NUMBER(S)

PERMIT / REGISTRY NUMBER(S)

ADDRESS

ADDRESS

(Please use as many copies of this page as necessary.)
TTB F 5000.31 (09/2007)

Definitions:
1. Agreement: This written agreement between TTB and the User.
2. Automated Electronic Payments: A Payment by electronic funds transfer using the Automated Clearing House payment
system.
3. Internal Revenue Code: Title 26, United States Code
4. Internet: The global computer network comprising interconnected networks using standard protocols.
5. Password: The verification used by the Pay.gov system to permit access by an identified username.
6. Pay.gov: The government’s electronic payment system running on a computer connected to the Internet to process and
submit forms.
7. System Access Request Form: A form prescribed by TTB for gathering personal identification data with regard to each
individual authorized to act on behalf of the User Company in the use of the Pay.gov system.
8. Username: The identification used to determine authorization, authority, and privileges for use of the Pay.gov system by
the individual to whom access permission has been granted.
9. User: Person with Signature authority who will enter data into the Pay.gov system for a User Company. Note: Users may
enter data for multiple User Companies.
10. User Company: Entity that has dealings with the Alcohol and Tobacco Tax and Trade Bureau.

Mail this completed form to:
National Revenue Center
550 Main St
Ste 8002
Cincinnati, OH 45202-5215
TTB USE ONLY
TTB Official(s) Approval
SIGNATURE

SIGNATURE

NAME

NAME

Director, National Revenue Center

Branch Chief, National Revenue Center

TITLE

TITLE

DATE

DATE

PAPERWORK REDUCTION ACT NOTICE
This request is In accordance with the Paperwork Reduction Act of 1995. We use this information collection to identify, validate, approve, and register
qualified users to allow for submission of electronic forms using the Pay.gov system. The information we request is voluntary but is required for
enrollment in this program.
We estimate the average burden associated with this collection of information is 5 minutes per respondent or recordkeeper, depending on your individual
circumstances. Address your comments concerning the accuracy of this burden estimate and suggestions to reduce this burden to the Reports Management
Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220.
An agency may not conduct or sponsor, and an individual is not required to respond to, a collection of information unless it displays a current, valid OMB
control number.

PRIVACY ACT STATEMENT
We provide this information to comply with Section 3 of the Privacy Act of 1974 (5 U.S.C. 552(a)(e)(3)).
We request this information under the authority of 27 CFR Chapter 1 Part 73 Subpart C, and 26 U.S.C.- 6011, 6061, and 7502. The information requested
is used to identify, validate, approve, and register qualified users to allow for submission of electronic forms using the Pay.gov System.
We use this information to make determinations for the purposes described in paragraph 2. Also we may disclose the information to other Federal, State,
foreign, and local law enforcement and regulatory agency personnel to verify information on the form where law does not prohibit such disclosure. We
may disclose the information to the Justice Department if it appears that the furnishing of false information may constitute a violation of Federal law.
Finally, we may disclose the information to members of the public in order to verify information on the form where law does not prohibit such disclosure.
If you fail to supply complete information, there will be a delay in our approval of your participation in this program.

TTB F 5000.31 (09/2007)