3881 ACH Vendor Miscellaneous Payment Enrollment OMB Number-2026

1. Click ‘Get Form’ to open the 3881 ACH Vendor Miscellaneous Payment Enrollment form in the editor.
2. Begin by filling out the 'Medical Provider Information' section. Enter your OWCP Provider ID, name, address, contact person’s name, and telephone number accurately.
3. Next, complete the 'Agency Information' section. Provide the name of the agency (U.S. Department of Labor-Office of Workers’ Compensation Program) and their address. Include a contact person's name and telephone number if applicable.
4. Proceed to the 'Financial Institution Information' section. Fill in your financial institution's name, street address, city, state, zip code, and telephone number. Ensure you also provide the ACH Coordinator's name.
5. Input your nine-digit routing transit number, depositor account title, account number, and select the type of account (checking or savings).
6. Finally, sign and date the form where indicated. Make sure to include your title as a representative.

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