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 FedDirectory® provides a comprehensive list of service and support contacts that can assist you.

FedCash Services Forms
CASH-01FedCash Service Request Form
The FedCash Services Request form can be used to set up new endpoints, change existing endpoint information or cancel Cash Services and to 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-02Difference 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-03Deposit Adjustment Dispute Form
This form can be used to dispute an adjustment made to a deposit.
Form (PDF)
Instructions (PDF)
CASH-04FedCash 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-05Cross-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 submit the Waiver Request Form to the Customer Contact 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-06Cross-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 11/15/2014 and can be disputed through March 2015), and must be signed by an individual on the Official Authorized Signer list for your organization. The completed form should be emailed to the Customer Contact Center at ccc.bankservices@kc.frb.org or faxed to (877) 281-3647.

If email or fax is not an option, a signed hard copy can be mailed to Customer Contact 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-07Custodial 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-09UCAP 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)
CASH-10FedLine Web Cross Zone Form
Customers should use this to inform the Federal Reserve of their intention to use FedLine Web cash services for their institution's branches or endpoints, and/or institutions for which they are authorized to conduct cash business.
Form (PDF)
Instructions (PDF)

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District - Cash Forms and Agreements
FedCash Services forms for your District can be obtained by contacting your District FedCash Contacts, which can be found on the Contact Us page.

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