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ACH ROYALTY PAYMENT ENROLLMENT FORM This form is used for Automated Clearing House (ACH) payments with an addendum record that contains paymentrelated information processed through the Vendor Express Program AGENCY INFORMATION FEDERAL PROGRAM AGENCYCENTERS FOR DISEASE CONTROL & PREVENTION AGENCY IDENTIFIER:AGENCY LOCATION CODE (ALC):CDC ADDRESSP. O. BOX 15580ACH FORMAT:75090421CCD+CTXCTPMS TCU2ATLANTA, GA30333CONTACT PERSON NAME:TELEPHONE NUMBER:(678) 4754510Customer

How to fill out this form is used

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Who needs this form is used?

1. Individuals applying for a permit or license.
2. Employees needing to report their information.
3. Organizations filing for compliance or regulatory purposes.
4. Anyone required to provide specific information for administrative procedures.

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What is this form used for?

This form is used to report specific information as required by regulatory agencies, typically for tax or compliance purposes.

Who is required to file this form?

Individuals, businesses, or organizations that meet certain criteria set by the regulatory authority are required to file this form.

How to fill out this form?

To fill out this form, follow the instructions provided, ensuring that all required fields are completed accurately with the necessary information.

What is the purpose of this form?

The purpose of this form is to collect pertinent data that helps the regulatory body fulfill its oversight responsibilities and ensure compliance with laws.

What information must be reported on this form?

Typically, the form requires specific details such as personal identification information, financial data, and any relevant disclosures related to the reportable activity.