Check 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 or need assistance in completing the agreements and/or forms below, My FedDirectory® provides a comprehensive list of service and support contacts that can assist you.

Check Services Agreements

The agreements below must be completed and signed by an authorized individual listed on the institution’s Official Authorization List (OAL) on file at the Federal Reserve Bank.

If a financial institution has updates to an existing agreement, only applicable portions should be completed and signed. Agreements must be returned to:

E-mail: ccc.bankservices@kc.frb.org

Fax:
877-281-3647

Mail:
Customer Contact Center
P.O. Box 219416
Kansas City, MO 64121-9416

Check 21 Services Agreement and Set Up Form (v 7.4)
Completion of this form is required before a financial institution may send electronic items to a Federal Reserve Bank, receive electronic items from a Federal Reserve Bank, or send to a Reserve Bank physical items that are designated for processing under Appendix G of Federal Reserve Bank Operating Circular 3 (collectively, “Items”). The Federal Reserve Bank uses this form to obtain information that is needed to successfully complete “Check 21” product enrollment and set-up processes.
Form (PDF)
Check 21 Agency Agreement (v 4.0)
This agreement appoints an agent for accessing Federal Reserve Bank Check Collection and Return Services.
Form (PDF)
Check Presentment and Return Agreement
This agreement sets forth the terms of our PDF Check Presentment and Return Service.
Form (PDF)

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Check Adjustments Services

The following electronic forms are available to support processing of all check adjustment requests. For more information on the required forms, visit the Check Adjustments Quick Reference Guide

Check Adjustments Request Form Form (PDF)
Check 21 Warranty/Indemnity Claim Form Form (PDF)
Claim of Late Return Form (PDF)
Claim of Damage Due to an Underencoding Form (PDF)
Document-to-Follow (DTF) Fax Cover Sheet Form (PDF)
Expedited Recredit Claim Form Form (PDF)
Paying Bank's Response to a Claim of Late Return Form (PDF)

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Cash Letter Forms

Standardized cash letter forms are offered for your use when sending cash letters to the Federal Reserve Bank of Atlanta at the address noted on the form. These forms will open in Microsoft® Excel® and can be completed when opened from the website, or saved to your computer for later use.

Savings Bond
Image-Enabled Savings Bond Processing provides financial institutions with the ability to deposit image-eligible savings bonds in mixed and separately sorted FedForward® Image Cash Letters (ICLs) and separately sorted paper cash letters. While image-based savings bond processing is strongly preferred, paper savings bond deposits are also accepted. Refer to the Image-enabled Savings Bond Processing Quick Reference Guide (PDF) for more information.

  • Regular Savings Bond
    The Regular Savings Bond cash letter form should be used for all eligible card style and half sheet bonds.
    Form (XLS)
    Instructions (PDF)

  • Full-Sheet Savings Bond
    The Full-Sheet Savings Bond cash letter form should be used for older bonds that were issued on full-sheet certificates which, because of their age, are fairly rare.
    Form (XLS)
    Instructions (PDF)

  • Facsimile Savings Bond
    The Facsimile Savings Bond cash letter form should only be used for properly prepared facsimiles of bonds that were lost or destroyed in transit.
    Form (XLS)
    Instructions (PDF)

Canadian Item
The Federal Reserve Banks offer a Canadian item clearing service for items denominated in either U.S. dollars or Canadian dollars. Canadian checks must be sorted into the proper cash letter according to whether they are denominated in U.S. or Canadian dollars.

Every effort will be made to correctly process forward items deposited in mismatched cash letters. However, any item sent in the wrong cash letter type will be subject to a Cash Letter Correction fee, in addition to the forward collection fee, or may be sent back to you as a return item with a return item fee charged.

  • Canadian Item U.S. Funds Encoded
    The Canadian Item U.S. Funds Encoded cash letter form should be used for Magnetic Ink Character Recognition (MICR) encoded items, payable in U.S. funds, drawn on a Canadian bank. Refer to the instructions for more information.
    Form (XLS)
    Instructions (PDF)

  • Canadian Item U.S. Funds Unencoded
    The Canadian Item U.S. Funds Unencoded cash letter form should be used for unencoded items, payable in U.S. funds, drawn on a Canadian Bank. Refer to the instructions for more information.
    Form (XLS)
    Instructions (PDF)

  • Canadian Item Canadian Funds Encoded
    The Canadian Item Canadian Funds Encoded cash letter form should be used for Magnetic Ink Character Recognition (MICR) encoded items, payable in Canadian funds, drawn on a Canadian Bank. Refer to the instructions for more information.
    Form (XLS)
    Instructions (PDF)

  • Canadian Item Canadian Funds Unencoded
    The Canadian Item Canadian Funds Unencoded cash letter form should be used for unencoded items, payable in Canadian funds, drawn on a Canadian Bank. Refer to the instructions for more information.
    Form (XLS)
    Instructions (PDF)

Foreign Item
The Foreign Item cash letter form is used to deposit items drawn on depository institutions outside of the Federal Reserve System, other than Canada. Use the applicable Canadian Item cash letter form for items drawn on Canadian banks.
Form (XLS) Instructions (PDF)

Forward Item
The Federal Reserve Banks' Paper Check Clearing Services allow financial institutions to deposit paper forward items. These services are especially beneficial in contingency situations when you or your vendor is unable to send an image cash letter file.

  • Mixed Regular Encoded
    The Mixed Regular Encoded cash letter form should be used for Magnetic Ink Character Recognition (MICR) encoded Forward Collection items of various types. For example, Forward items, including commercial checks, Treasury checks, and Postal Money Orders, can be deposited in a single cash letter.

    Paper Savings Bonds and Canadian items must be deposited in a separate cash letter using the applicable Savings Bond or Canadian Item cash letter form. Also, use the Foreign Item cash letter form to deposit all other foreign items.
    Form (XLS)
    Instructions (PDF)

  • Mixed Regular Unencoded
    The Mixed Regular Unencoded cash letter form should be used for unencoded Forward Collection items of various types. For example, Forward items, including commercial checks, Treasury checks, and Postal Money Orders, can be deposited in a single cash letter.

    Paper Savings Bonds and Canadian items must be deposited in a separate cash letter using the applicable Savings Bond or Canadian Item cash letter form. Also, use the Foreign Item cash letter form to deposit all other foreign items.
    Form (XLS)
    Instructions (PDF)

  • Same Day Settlement
    The Same Day Settlement (SDS) fine sort cash letter form is used to deposit items drawn on institutions that subscribe to FedReceipt® Plus and have elected the Federal Reserve Bank to be a presentment point.
    Form (XLS)
    Instructions (PDF)

Forward Not Our Item
The Forward Not Our Item cash letter form should be used for items charged in a Forward cash letter (inclearings) which does not bear the receiving institution's routing number in the Magnetic Ink Character Recognition (MICR) line of the physical item, image or in the associated MICR record for items received electronically. Refer to the instructions for more information.
Form (XLS) Instructions (PDF)

Government Item
The Government Item cash letter form should be used for items issued by the U.S. Treasury.
Form (XLS) Instructions (PDF)

Image Only - Non Deposit
The Image Only - Non Deposit cash letter form should be used for items that are imaged only; not processed for payment/return.
Form (XLS) Instructions (PDF)

Postal Money Order
The Postal Money Order cash letter form should be used for U.S. Postal Money Orders.
Form (XLS) Instructions (PDF)

Return Item
The Federal Reserve Banks' Paper Check Clearing Services allow financial institutions to deposit paper return items. These services are especially beneficial in contingency situations when you or your vendor is unable to send an image return letter file.

  • Qualified Mixed Return Item
    The Qualified Mixed Return Item cash letter form should be used for dishonored check items that have been prepared for automated processing.
    Form (XLS)
    Instructions (PDF)

  • Unqualified Mixed Return Item
    The Unqualified Mixed Return Item cash letter form should be used for dishonored check items that have not been prepared for automated processing.
    Form (XLS)

  • Large Dollar Return Item Notification
    The Large Dollar Return Item Notification (LDRIN) cash letter form should be used for large dollar ($2,500 or more) dishonored items where the Federal Reserve Banks will notify the Bank of First Deposit (BOFD).
    Form (XLS)

Return Not Our Item
The Return Not Our Item cash letter form should be used for items charged in a Return letter (charge back) which does not bear the receiving institution's routing number in the endorsement area of the physical item, image or in the associated endorsement records for items received electronically.
Form (XLS) Instructions (PDF)

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Vendor Profile Form
Vendor Profile Form
Completion of the form allows the Federal Reserve Banks to notify vendors supporting our Check Services about announcements that affect software vendors.
Form (DOC)

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Additional Check Services Enrollment Forms
Foreign Check Sign-Up Agreement Form

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