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US-DBC FORM 3212 SD \

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

Effective: February 05, 2025

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

OMB Control Number: 3212-0513

Related Programs: RPAF-Second Draw

File size: 591KB

REFUND PROCESSING AUTHORIZATION FEE PROGRAM

SECOND DRAW APPLICATION FORM

Revised February 05, 2025

Control No.: 3212-0513
Expiration Date: 08/01/2025

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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 separate sheet if necessary.

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Did you receive Refund PAF First Draw?

Variations of this document

Version I

Version H

Version G

Version F

Version D

Version C

Version B

Version A

| Effective: 2025-02-02

| Effective: 2025-02-02

| Effective: 2025-02-01

| Effective: 2025-02-01

| Effective: 2025-01-20

| Effective: 2025-01-19

| Effective: 2025-01-18

| Effective: 2025-01-11   

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

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