Repayment of Unspent Monetization Proceeds Wire Transfer and Agreement Closure Form

OMB Control No. 0551-0035

REPAYMENT OF FUNDS AND AGREEMENT CLOSURE

(Section 416(b)/Food for Progress/ McGovern-Dole)

TO: Director, Food Assistance Division

USDA/Foreign Agricultural Service

STOP 1034

1400 Independence Avenue, SW

Washington, DC 20250-1034

From:

Subject: Agreement _____________________________, Budget Number __________,

Country _________________

In accordance with the above referenced Agreement and Budget, we request closure of this agreement and agree to reimburse the outstanding amount of funds in the amount of $_____________________. This includes the deduction of unspent monetization funds originally allocated for projects.

Repayment by wire transfer please use the following information:

ABA No.:	021-030-004
Bank Name:	Treasury, NYC
Type Code:	CTR
Beneficiary (BNF):	Commodity Credit Corporation
Account No. (ALC)	4992
Bank to Bank Information (BBI):	Program Type:
	Country Name:
	Agreement No:
	Type of Cost:	Administrative Expense

Please notify Food Assistance Division either by phone (202) 720-4221 or by E-mail [email protected] when wire transfer has taken place.

Sincerely

For USDA use. ____________________________________ Branch Chief Date

The public reporting burden for this information collection is estimated to be 10 minutes. This burden estimate includes time for reviewing instructions, researching existing data sources, gathering and maintaining the needed data, and completing and submitting the information. Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to: U.S. Department of Agriculture, Foreign Agricultural Service, Office of Capacity Building and Development, Food Assistance Division, Attn: OMB Number (0551-0035), 1400 Independence Avenue., S.W., Washington, DC 20250-1034. You are not required to respond to this collection of information unless a valid OMB control number is displayed.