ACH VENDOR/MISCELLANEOUS PAYMENT 
ENROLLMENT FORM 
OMB No. 1510-0056 
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains 
payment-related information processed through the Vendor Express Program. Recipients of these 
payments should bring this information to the attention of their financial institution when presenting this 
form for completion. See reverse for additional instructions. 
PRIVACY ACT STATEMENT 
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All 
information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 
210. This information will be used by the Treasury Department to transmit payment data, by 
electronic means to vendor's financial institution. Failure to provide the requested information may 
delay or prevent the receipt of payments through the Automated Clearing House Payment System. 
AGENCY INFORMATION 
FEDERAL PROGRAM AGENCY 
AGENCY IDENTIFIER: AGENCY LOCATION CODE (ALC): ACH FORMAT: 
CCD+ CTX 
ADDRESS: 
CONTACT PERSON NAME: TELEPHONE NUMBER: 
( 
ADDITIONAL INFORMATION: 
) 
PAYEE/COMPANY INFORMATION 
NAME SSN NO. OR TAXPAYER ID NO. 
ADDRESS 
CONTACT PERSON NAME: TELEPHONE NUMBER: 
( ) 
FINANCIAL INSTITUTION INFORMATION 
NAME: 
ADDRESS: 
ACH COORDINATOR NAME: TELEPHONE NUMBER: 
NINE-DIGIT ROUTING TRANSIT NUMBER: 
DEPOSITOR ACCOUNT TITLE: 
DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER: 
TYPE OF ACCOUNT: 
CHECKING SAVINGS LOCKBOX 
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: 
(Could be the same as ACH Coordinator) 
TELEPHONE NUMBER: 
( 
( 
) 
) 
SF 3881 (Rev. 2/2003 ) 
31 U S C 3322; 31 CFR 210 
AUTHORIZED FOR LOCAL REPRODUCTION 
Prescribed by Department of Treasury 
Instructions for Completing SF 3881 Form 
Make three copies of form after completing. Copy 1 is the Agency Copy; copy 2 is the 
Payee/Company Copy; and copy 3 is the Financial Institution Copy. 
1.	 Agency Information Section - Federal agency prints or types the name and address of 
the Federal program agency originating the vendor/miscellaneous payment, agency 
identifier, agency location code, contact person name and telephone number of the 
agency. Also, the appropriate box for ACH format is checked. 
2.	 Payee/Company Information Section - Payee prints or types the name of the 
payee/company and address that will receive ACH vendor/miscellaneous payments, 
social security or taxpayer ID number, and contact person name and telephone number 
of the payee/company. Payee also verifies depositor account number, account title, and 
type of account entered by your financial institution in the Financial Institution 
Information Section. 
3.	 Financial Institution Information Section - Financial institution prints or types the name 
and address of the payee/company's financial institution who will receive the ACH 
payment, ACH coordinator name and telephone number, nine-digit routing transit 
number, depositor (payee/company) account title and account number. Also, the box 
for type of account is checked, and the signature, title, and telephone number of the 
appropriate financial institution official are included. 
Burden Estimate Statement 
The estimated average burden associated with this collection of information is 15 minutes 
per respondent or recordkeeper, depending on individual circumstances. Comments 
concerning the accuracy of this burden estimate and suggestions for reducing this burden 
should be directed to the Financial Management Service, Facilities Management Division, 
Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD 
20782 and the Office of Management and Budget, Paperwork Reduction Project 
(1510-0056), Washington, DC 20503.