Form NCUA 2005 Authorization Agreement for Electronic Funds Transfers Payments

OMB Control No. 3133-0135
Expiration Date: 9/30/2026

National Credit Union Administration
AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER PAYMENTS
In accordance with the Debt Collection Improvement Act of 1996 (Public Law 104-134), the National Credit Union
Administration (NCUA) must make payments to credit unions by Electronic Funds Transfer (EFT).
PART I – MUST BE COMPLETED – Please print
NCUA CHARTER NUMBER (FCU) OR INSURANCE CERTIFICATE (FISCU)
CREDIT UNION NAME
ADDRESS
CITY

STATE

ZIP

EMPLOYER’S ID NO. [TAXPAYER ID NO].
CONTACT PERSON

PHONE NO.

EMAIL
FINANCIAL INSTITUTION NAME
9-DIGIT ROUTING & TRANSIT NO. (RTN)
ACCOUNT NO.
(Must be at least 4 digits, and only contain numbers, spaces, or dashes)
If using a Corporate credit union, please contact them to verify the correct RTN and account numbers for FedACH use.

PART II – HIGHLY RECOMMEND
Pursuant to Executive Order 14247, the NCUA no longer accepts checks as a form of payment. Credit unions
are invited to enroll in the U.S. Department of Treasury Pay.gov direct debit program. Once enrolled, the NCUA
will automatically debit the invoice amount from your account, ensuring timely payment.

Yes, please direct debit my credit union’s invoiced amounts through Pay.Gov.
PART III – MUST BE COMPLETED
I authorize the NCUA to initiate electronic funds transfer payments to the credit union (and from the credit union if
direct debit option was elected).
This authorization replaces all previous authorizations and remains in full force and effect unless NCUA receives a new
authorization, 30 days prior to the next established payment date.

NAME OF AUTHORIZED
REPRESENTATIVE

TITLE

SIGNED

DATE
PLEASE KEEP A COPY FOR YOUR RECORDS.

Please complete and return to:
By Fax to:
703-837-2400
By Email to:
ncusifach@ncua.gov

National Credit Union Administration
OR
By Mail to:
National Credit Union Administration
Office of the Chief Financial Officer
1775 Duke Street
Alexandria, VA 22314-3428

PAPERWORK REDUCTION ACT STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
The time required to complete this collection of information is estimated to average 15 minutes per response. This includes time for reviewing the instructions, gathering needed information, and completing and
reviewing the information. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send comments to ncusif@ncua.gov.
PRIVACY NOTICE: The personally identifiable information collected is used for following up with individuals regarding their interactions with federal and federally insured credit unions. NCUA securely maintains all personally
Identifiable information provided via emails and mail, and only shares it outside of NCUA if required by law or regulation. For additional information, please contact privacy@ncua.gov.
NCUA 2005