FedCash® Services Forms

Use the links below to access the forms and agreements you will need to set up or use Federal Reserve Financial Services.

Service and Access Setup provides more details and guidance on the steps required to begin using a new service or to modify current services or access.

If you are unable to locate the form you seek, My FedDirectorySM provides a comprehensive list of service and support contacts who can assist you.

FedCash Services Forms
FedCash Services-Cross Zone Form
This is to inform the Federal Reserve Bank of our intention to use FedLine® Web cash services for the branches listed below. These represent branches or endpoints of our institution, or of institutions for which we are authorized to conduct cash business. Branch identifier change requests are indicated in the last two columns, if applicable, and changes should be effective on the effective date noted above.
 Form (PDF)
Instructions (PDF)
UCAP Designation Change Request Form
The Cash Services UCAP Change Request form can be used to designate endpoints as free or charged. The Uniform Cash Access Policy (UCAP) provides financial institutions a basic level of free access to cash orders and deposits. Service beyond the basic level may be subject to an access fee depending on volume and frequency of service. 		Form (PDF)
Instructions (PDF)
Difference Claim Request
This form can be used to submit claims for piece level differences found in currency and coin shipments received from the Federal Reserve. 		Form (PDF)
Instructions (PDF)
Cash Services Request Form
The Cash Services Request form can be used to set up new endpoints, change existing endpoint information or cancel Cash Services. In order to use this form to set up cash services, your institution must already have a Master Account Agreement or Transaction and Service Fee Settlement Authorization form on file. 		Form (PDF)
Instructions (PDF)

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Recirculation Policy Applications
Custodial Inventory (CI) Application
This form can be used to apply for a Custodial Inventory. To apply for a Custodial Inventory (CI). A custodial inventory enables an institution to transfer currency to the Federal Reserve Bank's books, but physically hold the currency within their secured facility, thereby reducing the investment cost of holding currency long enough to recirculate it to customers. The Custodial Inventory program is applicable only to $10 and $20 notes. Please note, submitting an application does not mean automatic acceptance into the program. The institution and site must pass the review process first. For more information on the Custodial Inventory program, please visit the Custodial Inventory web page. 		Form (PDF)
Federal Reserve Banks Sub zone Designation Change Request
This form can be used to change the zone or sub zone designation of an endpoint. 		Form (PDF)
Cross-shipping Waiver Request Form
This form can be used to request relief from cross-shipping fees due to a very serious disruption to cash flows, such as that caused by flooding in the main vault or a major service disruption. Customers who experience special circumstances that they believe qualify for a waiver should notify their Federal Reserve cash office within 5 business days of the onset of the situation and submit the Waiver Request Form to that office. The Federal Reserve cash office will decide whether the circumstances warrant cross shipping relief. 		Form (PDF)
Cross-shipping Adjustment Request Form
This form can be used to request an adjustment to incorrect charges for service area 6303.All requests must be submitted within the quarter following the settlement date. (E.g., the 3rd quarter bill will settle on 11/15/2007 and can be disputed through March 2008), and must be signed by an individual on the Official Authorized Signer list for your organization. The completed form should be faxed to your local Federal Reserve cash office or a Customer Support Help Desk if available in your District. Visit Contact Us to locate your local cash contact. Adjustments do not appear on cross-shipping reports, only on billing statements in the month after the request has been submitted. 		Form (PDF)

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District - Cash Forms and Agreements
Kansas City
Coin Deposit Tickets Form (PDF)
Currency Deposit Tickets Form (PDF)
New York
Cash Services Supply Request Form (PDF)
Richmond
Cash Services Special Request Form Form (PDF)
San Francisco
Special Request Fax Form
(Customers in Portland, Salt Lake City and Seattle Zones) 		Form (PDF)
Special Request Fax Form
(Customers in Los Angeles, Phoenix, and San Francisco Zones) 		Form (PDF)

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