Miscellaneous payment 2003-2019 form: Fill out & sign online

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Begin with the Agency Information Section. Enter the name and address of the Federal program agency, along with the agency identifier and location code. Ensure you provide a contact person’s name and telephone number, and select the appropriate ACH format.
Next, move to the Payee/Company Information Section. Fill in the payee's name, address, and either Social Security Number or Taxpayer ID Number. Include a contact person's name and phone number for the payee/company.
In the Financial Institution Information Section, input your financial institution's name and address. Provide details for the ACH coordinator, including their name and phone number. Don’t forget to enter your nine-digit routing transit number, account title, and account number.
Finally, ensure that an authorized official signs off on the form by providing their title and telephone number before making three copies as instructed.

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