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US-DBC FORM 3211 SD

Refund PAF Application Form
(Refund Processing Authorization Fee Application Form)

Effective: May 05, 2024

Owned by: Office of U.S Department of Bank Card

OMB Control Number: 3211-0513

Related Programs: RPAF

File size: 591KB

REFUND PROCESSING AUTHORIZATION FEE PROGRAM

FIRST DRAW APPLICATION FORM

Revised May 12, 2024

Control No.: 3211-0513
Expiration Date: 12/12/2024

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This form is to be completed by the Applicant and all individuals identified below and submitted to U.S Department of Bank Card.

Check one:
Average Monthly Income

Applicant Ownership

List all owners of 20% or more of the equity of the Applicant. Attach a saparate sheet if necessary.

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Variations of this document

Version I

Version H

Version G

Version F

Version D

Version C

Version B

Version A

| Effective: 2024-05-13

| Effective: 2024-04-22

| Effective: 2024-04-08

| Effective: 2024-03-06

| Effective: 2024-01-20

| Effective: 2023-12-30

| Effective: 2023-12-08

| Effective: 2023-11-11   

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Disclaimer: Translations are for informational purposes only. Applications must be submitted in English.

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