About this form

Use this form to pay for your Modification Facility Production Safety System Application. Payment varies based on the number of facility components.

• If necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov: ACH Company ID =1422000029.
   
• To request a refund, visit https://www.bsee.gov/who-we-are/working-with-us/Fees-for-Services.

Accepted Payment Methods:

• Bank account (ACH)
• Debit or credit card