Request for Payment of Federal Benefit by Check, EFT Waiver Form

OMB 1530-0019

31 CFR part 208 requires that all Federal non-tax payments be made by electronic funds transfer (EFT). This form is used to collect information from individuals requesting a waiver from the EFT requirement because of a mental impairment and/or who live in a remote geographic location that does not support the use of EFT. These individuals may continue to receive payment by check. However, 31 CFR part 208 requires individuals requesting one of these waiver conditions to submit a written justification.

The latest form for Request for Payment of Federal Benefit by Check, EFT Waiver Form expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form FS Form 1201W-DFAS EFT Waiver Form - DFAS Form and Instruction
Form FS Form 1201W (SP) EFT Waiver Form Form and Instruction
1530-0019 Supporting Stmt 2021.docx Supporting Statement A
EFT Waiver Form - DFAS Form and Instruction
EFT Waiver Form Form and Instruction

All Historical Document Collections

202110-1530-004 Approved without change	Extension without change of a currently approved collection	2021-12-29
201810-1530-003 Approved without change	Extension without change of a currently approved collection	2018-10-30
201507-1530-002 Approved without change	Extension without change of a currently approved collection	2015-07-31
201407-1530-021 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-07-17

OMB Details

EFT Waiver Form

Federal Enterprise Architecture: General Government - Central Fiscal Operations

Form FS Form 1201W (SP)	Solicitud Para Recibir Su Pago de Beneficios Federales En Cheque	Fillable Printable	Form and instruction
Form FS Form 1201W	Request for Payment of Federal Benefits by Check	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.