CBP ACH REFUND ENROLLMENT FORM
Description:
If you are a Harmed Domestic Producer, or an individual receiving a refund for a fine or penalty, use this Pay.gov form to enroll in electronic ACH refunds. Importers, brokers, filers, sureties, service providers, facility operators, foreign trade zone operators, and carriers are required to use their ACE Portal account to enroll in electronic refunds.
Form Number:
CBP ACH REFUND ENROLLMENT FORM
DMEA Commercial Services Agreement ACH Credit
Description:
Please use this form to pay your Commercial Services Agreement for DMEA services. This form is for DMEA customers only.
Form Number:
DMEA CSA Collections - ACH Credit
Library of Congress Cable Royalty Payment - ACH Credit
Description:
Use this form to pay royalty and filing fees using ACH credit.
Form Number:
LOCCableACHCredit
Library of Congress DART Royalty Payment - ACH Credit
Description:
Use this form to pay royalty fees using ACH credit.
Form Number:
LOCDartACHCredit
Library of Congress Satellite Royalty Payment - ACH Credit
Description:
Use this form to pay royalty and filing fees using ACH credit.
Form Number:
LOCSatelliteACHCredit
Irwin Army Community Hospital (0057)
Description:
Conveniently use this form to pay your bill received from Irwin ACH Ft Riley (0057) or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number:
DHA IRWIN ACH (0057)
Bassett Army Community Hospital (0005)
Description:
Conveniently use this form to pay your bill received from Bassett Army Community Hospital and associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number:
DHA Bassett ACH (0005)
Bayne-Jones Army Community Hospital (0064)
Description:
Please use this link to pay medical bills.
Form Number:
DHA Bayne Jones ACH 0064
Evans Army Community Hospital (0032)
Description:
Conveniently use this form to pay your bill received from Evans Army Community Hospital or associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number:
Evans ACH FT Carson 0032
General Leonard Wood Army Community Hospital (0075)
Description:
Conveniently use this form to pay your bill received from Leonard Wood Army Community Hospital (0075) and associated facilities for the medical service provided. You can pay with your credit card or an electronic fund transfer from your checking/saving account.
Form Number:
DHA Leonard Wood ACH (0075)
Weed Army Community Hospital (0131)
Description:
Please use this link to pay medical bills.
Form Number:
DHA WEED ACH (0131)
CMS Health Insurance Marketplace and Premium Stabilization Programs Payment Form
Description:
Please use this form to pay amounts owed related to the Health Insurance Marketplace and Premium Stabilization Programs. Additionally, if necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov on your dunning letter/invoice: ACH Company Name: USDEPTHHSCMS...Agency Company ID: 7505008014
Form Number:
HHSCIIO
OMB Number:
0938-1187
Counsel Rulings User Fees
Description:
Use this form to pay your User Fee Payment. If necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov: ACH Company ID: 2009000325
Form Number:
1128, 2553, 3115, 8716
Counsel Supplemental User Fees
Description:
Use this form to pay your supplemental User Fee. If necessary, provide the following information to your bank to prevent debit blocking on the payments processed through Pay.gov: ACH Company ID: 2009000325
Form Number:
Supplemental 1128, 2553, 3115, 8716
Department of State Salary Overpayment Debts
Description:
Use this form to make collections via ACH, Credit Card, Debit Card, or Digital Wallet for salary overpayment debts.
