RD 1951-66 Fedwire Worksheet

Form RD 1951-66
(10-03)

Form Approved
OMB No. 0575-0184

FEDWIRE WORKSHEET
(1) Date to Process Wire : ____ -____ - ________
MM
DD
CCYY
(4) BENEFICIARY DATA (BNF)

(2) SENDER F.I. DATA (ODFI)
Financial Institution Name/Address

Federal Agency Name/Location/Phone
USDA Rural Development
Cash Management Branch
Mail Code FC 363
P.O. Box 200011
St. Louis, MO 63120-0011

(3) FUNDS DATA (OGB)
Payor Information
Bank Account No. ____________________________

(5) RECEIVER F.I. DATA (RDFI)
Wire Field
Wire Data

Routing Transit No.
Name on Acct : _______________________________ Financial Institution:
Business Function Code:
Ttl Amt to Wire : $________________________ . ___ Beneficiary ID:
___________________________________________ Account:
Financial Institution Name
Beneficiary Name:
Beneficiary Addr /Line 1:
Beneficiary Addr /Line 2:
Routing Transit No.

021030004
TREAS NYC
CTR
D
12200408
TREASURY
NY
NY

Tag
(3400)/Field 1
(3400)/Field 2
(3600)
(4200)/Field 1
(4200)/Field 2
(4200)/Field 3
(4200)/Field 4
(4200)/Field 5

(6) ORIGINATOR to BENEFICARY DATA
Required Info. by Originator: { } / Optional Info. Further Application Instructions: [ ] / Required Sign: ( )
N = Max. Numeric Digits / T = Max. Text Digits / D = Max. Numeric with2 Pos. Decimal
Wire Field
Wire Data
Tag
Message for Wire (No spaces between Digits)
ORG (5000)
Originator ID
1T
Field 1 D
{Taxpayer ID No.}
2N (-) 7N
Field 2 __ __ - __ __ __ __ __ __ __ {Borrower Name}

35T

Field 3 ______________________________________

{Addr/Line1}

35T

Field 4 ______________________________________

{Addr/Line2}

35T

Field 5 ______________________________________

{City/State/Zip}

35T

Field 6 __________________________________

{Borrower Ref./Case No.}
{Loan Pgm-Amt}

OBI (6000)
Field 1 __ __ - __ __ __ - __ __ __ __ __ __ __ __ __ __

3T Pgm (-) 11D Amt
(/) 3T Pgm (-) 11D Amt

{ [Loan Pgm-Amt] }

3T Pgm (-) 11D Amt
(/) 3T Pgm (-) 11D Amt

{ [Advice Memo] }

35T

Field 2 __ __ __ - __ __ __ __ __ __ __ __ __ . __ __ /
__ __ __ - __ __ __ __ __ __ __ __ __ . __ __
Field 3 __ __ __ - __ __ __ __ __ __ __ __ __ . __ __ /
__ __ __ - __ __ __ __ __ __ __ __ __ . __ __
Field 4 _______________________________________

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection
of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0184. The
time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Privacy Act Statement
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on the form is required under
various provisions of title 15 U.S.C. 1601, 12 CFR 205 and 31 CFR 202, for the purpose of providing the authority to the Department of Treasury
to designate financial institutions to collect payments, by electronic means, from your account. The information will be used for identification with
the records of the government agency and the financial institution to direct your payments to the point you authorize.