Unified Dummy Test Form

Dummy Test Form

This form must be electronically filled out, no handwritten forms will be accepted.

Request Type:

Date of Request:

Select the date the request is being submitted.

Purpose of Request:

Select the purpose of the vendor request.

_{If the vendor is required to register in SAM.gov, please have them do so before completing this form. SAM.gov Registration exceptions can be found in FAR 4.1102. The assumption is that the SAM.gov information is valid. If the information currently listed at SAM.gov or in the UFMS is incorrect, then the vendor should be contacted to update their SAM.gov information}

Is Vendor Required to Register in SAM?

If No. What is the FAR Exemption?

USDOJ Component Information

Requesting Component:

Component Contact:

Office Phone Number:

Vendor Type:

UFMS Security Organization:

Payment Type:

- CCD: Cash Concentration or Disbursement - Select for corporate.
- Check: Select if vendor is requesting to be paid by.
- PPD: Prearranged Payment or Deposit - Select for personal account.

Prompt Pay Type:

Employee/Vendor/Payee Information

Vendor Name:

UEI-EFT:

Enter the Unique Entity Identifier (UEI) twelve alpha-numeric identification code assigned by SAM system. Followed by the four-didgit Electronic Funds Transfer (EFT) indicator for the designated bank account established to receive DOJ equitable sharing payments. If your SAM account is only affiliated with one bank you may use four zeros to satisfy the EFT indicator requirement. Please separate these codes with a dash. (e.g., 1AB23C456D89-1234)

Cage Code:

Enter the Commercial and Government Entity (CAGE) five-character ID number assigned in SAM.gov. (e.g., 123A5)

NCIC Code:

Enter National Crime Information Center (NCIC/ORI) Code.

This code begins with the two (2) letter acronym of your State, followed by seven (7) alpha-numeric. (e.g., TX1234567)

Enter Tax ID Number or SSN of the Payee who is legally entitled to the funds.

- EIN/TIN: If a business, select EIN/TIN and enter Tax ID Number (e.g. 12-3456789)
- SSN: If an individual, select SSN and enter the Social Security Number (e.g. 218-45-6789)

Street Address:

Country:

Zip Code (Postal Code):

Enter zip code for USA or postal code for international countries.

City:

State (Province):

For international addresses enter province code if applicable.

Email Address:

Phone Number:

Fax Number:

Contact Name:

TPID

Enter the CATS Third Party ID Number.

This number is 6-10 digits long and is typically conveyed in the subject of correspondence instructing you to complete the UFMS Vendor Request Form. Please contact the Agency that sent the correspondence should you have any questions regarding this field.

AIN Code:

Enter the CATS Asset ID Number.

This number consists of 13 characters, i.e. 12-DEA-123456 and is typically conveyed in the correspondence instructing you to complete the UFMS Vendor Request Form. Please contact the Agency that sent the correspondence should you have any questions regarding this field.

Financial Institution Information

Bank Name:

Enter the banking institution name receiving funds.

Street Address:

Enter the street address for the banking institution.

Zip:

Enter the zip code for the banking institution.

City:

Enter the cit for the banking institution.

State:

Enter the state for the banking institution.

Country:

Bank Phone Number:

ABA Number:

Enter the 9 Digit Routing Number for the bank holding the account where the funds are to be transferred.

Account Type:

Select the appropriate account type.

Account Type:

Select the appropriate account type.

Account Number:

Enter the Account Number where the funds are to be transferred.

Re-enter Account Number:

Enter the number again in the Re-enter Account Number field.

- Handwritten submissions: Form must be electronically filled out and submitted. Handwritten submissions, including pen-and-ink- changes, will be rejected.
- EIN/SSN/TIN: The Tax Identification Number (TIN) entered on the Form should be that of the person or entity who is legally entitled to the funds. Under no circumstances, should be presentative (attorney, next of kin, etc.) of the defendant, claimant, or petitioner enter their personal or business Tax Identification Number on the Form. You maybe asked to provide supporting documents to validate the Tax Identification Number. Individuals without a Tax Identification Number should use the Asset Forfeiture - Non-Citizen (Domestic) Payment Form.
- NCIC/TPID Code: For Department of Justice Equitable Sharing purposes, this number is your Agency's NCIC/ORI code (e.g., MD1234567). For all purposes, the TPID code is your 6-10 digits CATS Party ID Number (e.g., 1788649). This number is typically conveyed in the subject of correspondence instructing you to complete the UFMS Vendor Request Form. Please contact the Agency who sent you the correspondence should you have any questions regarding about the CATS Party ID Number. Please note, a CATS Asset ID Number (e.g., 19-DEA-123456) is not a valid entry.
- Financial Institution Information: Ensure the Payment Type is completed before atempting to complete Financial Institution Information. The ABA Number and Account Number must be able to accept Automated Clearing House (ACH) network payments. ABA Numbers and Account Numbers designated solely for Wires or Fedwires network payments result in a payment cancellation.
- Submission Timeframes: Generally, Forms are reviewed and processed within five (5) business days of submission date. Forms submitted between between September 25th and October 10th may take additional time due to annual system maintainance. The submitter and, if different, vendor contact indicated in Form will receive notice via e-mail from ACH Forms indicationg the status of the Form. The e-mail notice for successful Form will provide additional details about the forthcoming payment including points of contact.
- Payment Cancellation/Rejection Noices: If you have received and e-mail from ACH Forms indicating that your payment was either cancelled or rejected then there was a problem with your original Form submission. The reason for the cancellation/rejection and a brief description will be listed in the e-mail. Regardless of the reason, and an updated Vendor Request Form must be submitted to process your payment. Generally, the account number previously provided is either inaccurate or no longer valid in our system due to inactivity.

_{PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.}

If assistance needed or found problems with the Form please contact AFD.ACHForms@usdoj.gov