Electronic Funds Transfer Waiver Request Form

• Legal Form Number: 10-002
• Section: U.S. Immigration and Customs Enforcement
• Issuer: U.S. Immigration and Customs Enforcement

ALL VENDORS, SOLE PROPRIETORS AND INDIVIDUALS

INDIVIDUALS AND SOLE PROPRIETORS ONLY

DEPARTMENT OF HOMELAND SECURITY

U.S. Immigration and Customs Enforcement

ELECTRONIC FUNDS TRANSFER WAIVER REQUEST FORM

OMB No. 1653-0043

Expires 06/30/2025

Federal regulations 31 C.F.R. Part 208 and F.A.R. 32.11 give the Federal Government the authority to waive a vendor, sole proprietor, or

individual from the Electronic Funds Transfer (EFT) requirements of the Debt Collection Improvement Act (DCIA) if they meet one or more

of the seven conditions cited below. To request an EFT Waiver, please complete this form and submit it to Financial Service Center -

Dallas (FSC-D) by mail or facsimile for approval.

Vendor/Individual Name:

TIN (SSN, EIN, ITIN):

Address:

Point of Contact:

Phone No.: Facsimile No.:

E-mail Address:

Business Type: VENDOR-CORPORATION VENDOR-PARTNERSHIP VENDOR-SOLE PROPRIETOR

INDIVIDUAL

Employee Status: FEDERAL EMPLOYEE NON-FEDERAL EMPLOYEE

I request a waiver of the EFT payment requirement for the following reason(s):

Payee/Requester

Signature (Sign in ink)Date

For Office Use Only:

Approved Denied

Signature of Obligations Branch Manager

(Sign in ink)

RETURN TO:

Department of Homeland Security

ICE-OCFO-OFM-FSC-D

Attention: Deputy Division Chief Dallas Finance Center (DFC)

8222 N Beltline Road, Second Floor

Irving, TX 75063

Email: VendorMaintenance.DFC@ice.dhs.gov

ICE Form 10-002 (6/22)

Condition 1 - It presents an unreasonable hardship due to physical or mental disability; geographic, language or

literacy barrier; or financial impediment.

Condition 2 - The political, financial, or communications infrastructure in a foreign country (e.g., geographical

territories outside of the United States and Puerto Rico) does not support payment by EFT.

Condition 3 - Residence and duty station is designated as a disaster area. (This waiver is limited to payments

made within 120 days after the disaster is declared.)

Condition 4 - Payment by EFT is not possible or does not support the objectives of military operations, including

contingency/emergency operations or civil emergencies.

Condition 5 - Payment by EFT may pose a threat to national security, the life, or physical safety of an individual

may be endangered, or a law enforcement action may be compromised.

Condition 6 - The cost for making a payment by EFT exceeds the cost of making the payment by check and the

recipient expects to receive a single, non-recurring payment within a one-year period.

Condition 7 - Payment must be made by a method other than EFT where there is only one source or an

agency’s need for goods and services is of such unusual and compelling urgency and the Federal Government

would be seriously injured.

Effective Date

Date

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Bank Acct, Credit Card

or other Federal Acct No.

NON U.S. CITIZEN