• Agencies

Forfeiture Money Judgment Collection Form

Description: Please use this form to pay your court ordered forfeiture money judgment with the Department of Justice to the United States Marshals Service.
Form Number: USMS Money Judgment

1201 Borrower Payments

Form Number: 1201

Part D Manufacturer Discount Program (MDP) CMP Payment

Description: Use this form to pay the civil money penalty (CMP) imposed under the Part D Manufacturer Discount Program.
Form Number: Part D MDP Civil Money Penalty

Long Term Care/COVID-19/HHA/CLIA Civil Money Penalty (CMP) Payment

Description: Use this form to pay Long-term care, COVID-19, HHA or CLIA Civil Money Penalty.
Form Number: CMS CMP

FEC ADR Payment

Description: Use this form to pay your civil money penalty.
Form Number: ADR-01

FEC OGC Civil Penalty Payment

Description: Use this form to pay your civil money penalty.
Form Number: OGC-01

WHD Civil Money Penalty Payment Form - Midwest Region

Description: Use this form to pay your CMP payment to DOL WHD for the MW Region
Form Number: WHDCMPMW

WHD Civil Money Penalty Payment Form - Northeast Region

Description: Use this form to pay your CMP payment to DOL WHD for the NE Region.
Form Number: WHDCMPNE

WHD Civil Money Penalty Payment Form - Southeast Region

Description: Use this form to pay your CMP payment to DOL WHD for the SE Region
Form Number: WHDCMPSE

WHD Civil Money Penalty Payment Form - Southwest Region

Description: Use this form to pay your CMP payment to DOL WHD for the SW Region
Form Number: WHDCMPSW

WHD Civil Money Penalty Payment Form - Western Region

Description: Use this form to pay your CMP payment to DOL WHD for the WE Region
Form Number: WHDCMPWE

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