Sf-3881 - Ach

ACH PAYMENT ENROLLMENT FORM
This form is used for Automated Clearing House (ACH) payments. Recipients of these payments
should bring this information to the attention of their financial institution when presenting this form for
completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on
this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the
Treasury Department to transmit payment data, by electronic means to vendor’s financial institution. Failure to provide
the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment
System.

AGENCY INFORMATION
FEDERAL PROGRAM AGENCY

INSTITUTE OF MUSEUM AND LIBRARY SERVICES
AGENCY IDENTIFIER

AGENCY LOCATION CODE

ACH FORMAT

IMLS
ADDRESS
1800 M STREET, NW, 9TH FLOOR

59000004

CCD+

WASHINGTON, DC 20036-5802
TELEPHONE NUMBER

CONTACT PERSON NAME

Grants Administration

202-653-4737

PAYEE INFORMATION
NAME

SOCIAL SECURITY NO. OR TAXPAYER ID NO.

ADDRESS

IMLS GRANT NUMBER:

TELEPHONE NUMBER

CONTACT PERSON NAME

FINANCIAL INSTITUTION INFORMATION
NAME
ADDRESS

ACH COORDINATOR

TELEPHONE NUMBER

NINE-DIGIT ROUTING TRANSIT NUMBER
DEPOSITOR ACCOUNT TITLE
DEPOSITOR ACCOUNT NUMBER
TYPE OF ACCOUNT (please circle)

Checking

Savings

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL
(COULD BE THE SAME AS ACH COORDINATOR)

IOMB No. 1510-0058

Lockbox
TELEPHONE NUMBER

SF 3881

ACH PAYMENT ENROLLMENT FORM
INSTRUCTIONS
In a government-wide cost cutting effort, the U.S. Treasury has mandated that all
government payments be processed through an Electronic Funds Transfer system.
They have developed the Vendor Express to utilize the Automated Clearing House
(ACH) network to process financial transactions. This will allow IMLS to transfer funds
directly to your bank account.
To enroll in the program, please complete the “ACH Payment Enrollment Form,”
(SF-3881) on the front of this page, as follows:
1.

Complete the “Payee Information” section of the form. The “Contact Person
Name” must be the same person as the “Authorized Representative” listed
on your grant application.

2.

Ask your financial institution to complete the “Financial Institution Information”
section. This form should be signed by the ACH Coordinator at your bank.

3.

Make arrangements with your bank to be notified of deposit.

4.

Make a copy of the completed form for your files.

5.

Return the completed original form to the IMLS. Email the form in PDF format to
IMLS Grants Administration at [email protected]. If you do not have the
capability to email PDF documents, the form may be mailed to the address
shown in the “Agency Information” section no later than the date indicated in the
Memorandum.

PLEASE NOTE:
1.
2.

It is your responsibility to notify IMLS if your banking information changes
(i.e., you change account numbers, banks, etc.)
If you have other grants from IMLS, payments from those grant funds will
be direct deposited to the same bank account.

If you have questions, please call the IMLS Contact Person named in the “Agency
Information” section of the form.