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 will also contact the user
via telephone with a password that the user will be required to reset upon their 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 their 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 they 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 they 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 consent 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, they will immediately
notify the system administrator to report the problem. The user and the User Company also
acknowledge they are still 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.
TTB F 5000.31 (05/2008)

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 shall remain valid and unimpaired, and shall 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 shall be effective only after affixation of the
signatures of both parties’ representatives.
User Information:
Please use this section to show the information for the person requesting the ID.
__________________________________________
__________________________________________
Name
Date
__________________________________________
__________________________________________
Title
Email Address
__________________________________________
__________________________________________
Signature
Telephone Number
For Alcohol and Tobacco Companies only
I am requesting
Full Permissions to create, save, and submit reports and/or returns.
Full permissions users must have Signature Authority or Power of Attorney to Submit Returns and/or Reports.
Please use this section to detail your permissions:
I HAVE:

Signature Authority

Power of Attorney to submit Excise Tax

Blanket Power of Attorney

Power of Attorney to submit Operational Reports

I am requesting
Permissions to create, save, and reassign only.
Reassign users must have permission from someone with Signature Authority or Power of Attorney to get an
ID. Please use this section to show the authorization from someone with the proper permissions:

__________________________________________
Name
__________________________________________
Title
__________________________________________
Signature

__________________________________________
Date
__________________________________________
Email Address
__________________________________________
Telephone Number

I HAVE:

Signature Authority

Blanket Power of Attorney
TTB F 5000.31 (05/2008)

Please use this section to detail the information about your company. Use as many lines as necessary.
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
TTB F 5000.31 (05/2008)

__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address
__________________________________________
Company Name
__________________________________________
Taxpayer Identification Number
__________________________________________
Permit/Registry Number
__________________________________________
Address

You must mail the original completed user agreement to us at:
TTB Pay.gov Administrator
Alcohol and Tobacco Tax and Trade Bureau
8002 Federal Office Building
550 Main Street
Cincinnati, OH 45202
Appendix 1:
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 or Power of Attorney for a User Company that will use the Pay.gov
system to submit forms and/or payments to TTB. Note: Users may enter data for multiple User Companies.
10. User Company: Entity that has dealings with Alcohol and Tobacco Tax and Trade Bureau.
11. Reassign User: Person without Signature Authority or Power of Attorney that will enter data into the Pay.gov
system for a User Company. They then reassign the completed forms to a User for submission.
12. TTB: The Alcohol and Tobacco Tax and Trade Bureau

-----------------------------------------------------------TTB USE ONLY-----------------------------------------------------

TTB Official(s) Approval
__________________________________________
Signature
__________________________________________
Name
Director, National Revenue Center
Title
__________________________________________
Date

__________________________________________
Signature
__________________________________________
Name
Section Chief, National Revenue Center
Title
__________________________________________
Date

PAPERWORK REDUCTION ACT NOTICE
This request is in accordance with the, Paperwork Reduction Act of 1995. The information collection is used to obtain drawback of taxes on articles
which are exported. This information is required to obtain a benefit (26 USC 5062).The estimated average burden associated with this collection of
information is 2 hours per respondent or record keeper depending on individual circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be addressed 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 a person 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. 552a (e)(3)). We require this information under the authority
of 27 U.S.C. 205(e). You must disclose this information so we may verify your compliance with the Federal laws and regulations we administer for the
labeling of alcohol beverages. We use this information for the purposes described in the preceding paragraph. In addition, the information may be
disclosed to other Federal, State, and local law enforcement and regulatory agency personnel to verify information on the application and to aid in the
performance of their duties. The information may further be disclosed to the Justice Department if it appears that the furnishing of false information
may contribute to a violation of Federal law. Disclosure may otherwise be made pursuant to the routine uses most recently published in the Federal
Register for ATF's Regulatory Enforcement Records System (Treasury/ATF.008). If you fail to supply complete information, then there will be a delay
in the processing of your application.

TTB F 5000.31 (05/2008)