• Agencies

Form 5316, Application for Group or Pooled Trust Ruling

Description: Group/pooled trust sponsors file this form to request a determination letter from the IRS for a determination that the trust is a group trust arrangement as described in Rev. Rul. 81-100, 1981-1 C.B. 326, as clarified and modified by Rev. Rul. 2004-67, 2004-2 C.B. 28, and as modified by Rev. Rul. 2011-1, 2011-2 I.R.B. 251. See also Rev. Rul. 2014-24.

Estate Tax Closing Letter User Fee

Description: Use this form to request a closing letter and make your Estate Tax Closing Letter User Fee payment.
Form Number: Closing Letter

Determination Letters

Form Number: SBSE Determination Letter Fee

Department of Interior - IBC

Description: Please use this form to make payments for your overpayment letter sent to you by the Interior Business Center. Payments made by you will only be applied to the overpayment ID specific by you, this can be found on the overpayment letter above your name. If you do not have or know your overpayment ID please contact the Customer Service Center at 888-367-1622.

Application for Determination for Employee Benefit Plan

Description: Organizations file Form 5300 to request a determination letter from the IRS for the qualification of a defined benefit (DB) plan, defined contribution (DC) plan, or 403(b) plan and the exempt status of any related trust.
Form Number: 5300 Application for Determination for Employee Benefit Plan

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

Debt Payments for Contracts w/Pay Office F67100, F25700, F68300, F78900, F87700

Description: The DFAS Contractor Debt Payment form is used for the submission of funds on contracts where the payment office is listed as F67100, F25700, F68300, F78900 or F87700 (Limestone, ME). To ensure accurate routing of your payment, please check your demand letter on which DFAS site to send your payment to.

Department of Interior- IBC- Payroll- MSD

Description: Please use this form to make payments for your Military Service Deposit(MSD). Payments made by you will be applied to the amount described in your MSD letter from IBC. If you have questions about your MSD please contact the Customer Service Center at 888-367-1622.
Form Number: DOI - IBC - PAYROLL - MSD

DFAS Air Force or Space Force Contract Debt 3801

Description: The DFAS Air Force or Space Force Contract Debt 3801 form is used for the payment of C17 or C18 Bills of Collections (BOC) debt on contracts where the payment office is either DFAS Columbus (503000) or DFAS Limestone (667100/67900 /387700). To use this form to pay your debt, you must include a copy of your debt (demand) letter.
Form Number: DFAS AF SF Contract Debt 3801

DFAS Civilian Pay Debt Payment 8522

Description: The DFAS Civilian Pay Debt Payment Form is intended for use by federal civilian employees to make payments on their Civilian Pay indebtedness to the government amount due. This process cannot be utilized until after receipt of notification from the employee's servicing payroll office indicating the amount due. Specific information from the notification letter (database and employee ID) is required to complete the form.

DFAS Contractor Debt Payment 5570

Description: The DFAS Contractor Debt Payment 5570 form is used for the submission of funds where the contract payment office is listed as HQ0105, HQ0335, HQ0431, HQ0347, HQ0471, HQ0301, HQ0346, or HQ0345 and the Demand Letter states to send the funds to DFAS-IN AR.

DFAS Military Service Deposit Payment

Description: The Military Service Deposit Payment Form is intended for use by federal civilian employees to make payments on their Military Service Deposit (MSD) amount due. This form cannot be utilized until after receipt of notification from the employee's servicing payroll office indicating the amount due. Specific information from the notification letter (database and employee ID) is required to complete the form.

Form 4461

Description: A provider or mass submitter uses Form 4461, Application for Approval of Standardized or Nonstandardized Pre-Approved Defined Contribution Plan, to apply for an opinion letter for a pre-approved defined contribution plan.
Form Number: Form 4461
OMB Number: 1545-0169

Form 4461-A

Description: A provider or mass submitter uses Form 4461-A, Application for Approval of Standardized or Nonstandardized Pre-Approved Defined Benefit Plan, to apply for an opinion letter for a pre-approved defined benefit plan.
Form Number: Form 4461-A
OMB Number: 1545-0169

Form 4461-C

Description: A provider or mass submitter uses Form 4461-C, Application for Approval of Standardized or Nonstandardized 403(b) Pre-Approved Plan, to apply for an opinion letter for a pre-approved 403(b) plan.
Form Number: Form 4461-C
OMB Number: 1545-0169

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