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

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

OMB No. 1513-0117 (09/30/2013)
EFFECTIVE DATE

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 (04/2012)

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.
Date

Name
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

Date

Title

Telephone Number

Email Address

Signature

I HAVE:

Signature Authority

Blanket Power of Attorney
TTB F 5000.31 (04/2012)

Please use this section to detail the information about your company. Use as many lines as necessary.
Copy this page as many times as you need to identify all your locations.
Company Name

Company Name

Taxpayer Identification Number

Taxpayer Identification Number

Permit/Registry Number

Permit/Registry Number

Address

Address

Company Name

Company Name

Taxpayer Identification Number

Taxpayer Identification Number

Permit/Registry Number

Permit/Registry Number

Address

Address

Company Name

Company Name

Taxpayer Identification Number

Taxpayer Identification Number

Permit/Registry Number

Permit/Registry Number

Address

Address

TTB F 5000.31 (04/2012)

You must mail the original completed user agreement to us at:
Alcohol and Tobacco Tax and Trade Bureau (TTB)
550 Main Street, Room 8002
Cincinnati, OH 45202
Attn: Pay.gov
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 Official(s) Approval

TTB USE ONLY

Signature

Signature

Name

Name

Director, National Revenue Center

Chief, National Revenue Center

Date

Date

Title

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 record keeper,
depending on your individual circumstances. Address your
comments concerning the accuracy of this burden estimate and
suggestions to reduce this burden to Reports Management
Officer, Regulations and Procedures Division, Alcohol and
Tobacco Tax and Trade Bureau, 1310 G Street, NW, Box 12,
Washington, DC 20005. An agency may not conduct or sponsor,
and an individual is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.

Title

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 (04/2012)