• Agencies

IRS Certs

Description: Certs User Fee for IRS payment for Form 8802. Please use the agency tracking id on the confirmation as the electronic confirmation number

ID Attorney Admission Form

Description: Use this form to apply and pay for your attorney admission to the Idaho District and Bankruptcy Courts.
Form Number: ID Attorney Admission Payment

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.

.2016 ACA Transitional Reinsurance Program Annual Enrollment Contributions

Description: Please use this form ONLY to submit your 2016 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID - 7505008016 and Company Name - USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.
Form Number: ACA 2016
OMB Number: 0938-1155, 0938-1187

2014 ACA Transitional Reinsurance Program Annual Enrollment Contributions

Description: Please use this form ONLY to submit your 2014 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program.... ACH Company ID - 7505008015 and Company Name - USDEPTHHSCMS. Please use the Current Year ACA Transitional Reinsurance Program Annual Enrollment Contributions form to submit your Current Year contributions.
Form Number: ACA
OMB Number: 0938-1155, 0938-1187

2015 ACA Transitional Reinsurance Program Annual Enrollment Contributions

Description: Please use this form ONLY to submit your 2015 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program. ACH Company ID - 7505008015 and Company Name - USDEPTHHSCMS. Please email reinsurancecontributions@cms.hhs.gov if you need to submit your Previous Year's ACA Transitional Reinsurance Program Annual Enrollment Contributions form and contributions.
Form Number: ACA 2015
OMB Number: 0938-1155, 0938-1187

Card Acquiring Service Application

Description: Federal Agencies can use this form to apply for a Merchant ID so they can accept credit and debit cards.

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

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

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 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.

SGLI and FSGLI Premium Payments for Navy Reserves

Description: For Navy Reserve members that have received a billing statement, use the SGLI and FSGLI Premium Payments form to pay your Servicemembers' Group Life Insurance (SGLI) and Family Servicemembers' Group Life Insurance (FSGLI) premiums. The billing statement will include an employee ID number vs. a social security number to use on the pay.gov form.

NHTSA San Angelo Tire Track Usage Fee

Description: Use this form to pay usage fees
Form Number: NHTSA SATF
OMB Number: NHTSA SATF

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