Forms
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, Contact provides a comprehensive list of service and support contacts who can assist you.
Table of Contents
FedCash Services Forms
| Number | Form | Links |
|---|---|---|
| CASH-01 | FedCash Services Request Form The FedCash Services Request form can be used to set up new endpoints, change existing endpoint information, or cancel Cash Services, and make changes related to armored carrier transportation services to and from the Federal Reserve dock. 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) |
| CASH-02 | Difference Claim Request Form 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-03 | Deposit Adjustment Dispute Form This form can be used to dispute an adjustment that the Federal Reserve made to your institution’s deposit. | Form (PDF) Instructions (PDF) |
| CASH-04 | FedCash Services Contaminated Currency Form The FedCash Services Contaminated Currency form must be used to provide advance written notification to your local Federal Reserve Bank of an incoming deposit containing contaminated currency. For additional information and details, review the Contaminated Currency Procedures. | Form (PDF) |
| CASH-05 | 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 a disruptive weather or automation failure event. Customers who experience special circumstances that they believe qualify for a waiver should submit the Waiver Request Form to the Support Center within 5 business days of the onset of the situation. Your servicing Federal Reserve cash office will decide whether the circumstances warrant cross-shipping relief. | Form (PDF) |
| CASH-06 | 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 November 15, and can be disputed through the end of March the following year), and must be signed by an individual on the Official Authorized Signer list for your organization. The completed form should be emailed to the Support Center. If email or fax is not an option, a signed hard copy can be mailed to the Support Center, P.O. Box 219416, Kansas City, MO 64121-9416. Adjustments do not appear on cross-shipping reports, only on billing statements in the month after the request has been submitted. | Form (PDF) |
| CASH-07 | Custodial Inventory (CI) Application Form and Agreement This form can be used 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) |
| CASH-08 | Subzone Designation Change Request Form This form can be used to change the zone or subzone designation of an endpoint. | Form (PDF) |
| CASH-09 | UCAP Designation Change Request Form The Cash Services Uniform Cash Access Policy (UCAP) Change Request form can be used to designate endpoints as free or charged. The 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) |
| CASH-10 | FedLine Web Cross Zone Form This form is used to inform the Federal Reserve Bank of the intention to use FedLine Web cash services for the branches listed in the form. These represent branches or endpoints of the institution, or of institutions for which the requestor is authorized to conduct cash business. Branch identifier change requests should be indicated in the last two columns, if applicable, and changes should be effective on the effective date noted above. | Form (PDF) Instructions (PDF) |
District — Cash Forms and Agreements
FedCash Services forms for your District can be obtained by contacting your District FedCash Contacts.