31 CFR Part 208 Federal Agency Waiver Request Form

Fields marked with an asterisk(*) are required.

Incomplete forms will be returned to agency requesters for correction. Fiscal Service will review and approve or disapprove waiver requests within 60 calendar days from receipt of request. Approved waivers are only valid for one year from the date of approval.

For more information on Treasury’s electronic payment requirement, please visit https://www.fiscal.treasury.gov/payments-from-government/direct-deposit.

Agency Name:

Agency Location Code:

Agency Point of Contact:

(please include name, title, business e-mail address and business phone number)

Specific Waiver Requested:

§ 208.4(a)(1)(ii)

(seeking a waiver to continue to make payments by means other than EFT with respect to payments that may be delivered to a Treasury-sponsored account)

§ 208.4(a)(4)

(to extend the waiver for payments to disaster recipients beyond the initial 120-day period following when the disaster is declared)

§ 208.4(a)(8)

(where an agency's need for goods and services is of such unusual and compelling urgency that the Government would be seriously injured unless payment is made by a method other than electronic funds transfer)

§ 208.4(a)(8)

(where there is only one source for goods or services and the Government would be seriously injured unless payment is made by a method other than EFT)

(please select one of the following)

Written Explanation Justifying Waiver Request:

Projected Annual Payment Volume Impacted by Waiver:

Waiver Request Start Date:

Waiver Request End Date, if applicable:

Incomplete forms will be returned to agency requesters for correction. Fiscal Service will review and approve or disapprove waiver requests within 60 calendar days from receipt of request. Approved waivers are only valid for one year from the date of approval. For more information on Treasury’s electronic payment requirement, please visit https://www.fiscal.treasury.gov/eft.