Form CBP Form 7501A CBP Form 7501A Document/Payment Transmittal

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

OMB CONTROL NUMBER: 1651-0022
EXPIRATION DATE: 03/31/2025

DOCUMENT/PAYMENT TRANSMITTAL
Transaction Number (e.g., entry or entry summary number, action number)

Entry Date

Summary Date

Importer of Record Number

Team Number

COLLECTION INFORMATION (Complete only if payment attached)
Code
(001) Duty
(499) MPF
(501) HMF
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Comments:

An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB
control number and an expiration date. The control number for this collection is 1651-0022. The estimated average time to complete this application is 15
minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 90 K
Street, NE., Washington, DC 20002.

CBP Form 7501A (01/24)

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