Fees for Service Refund Request

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Fees for Service Refund Request

Privacy Act Statement:

Authority: The information requested is authorized by 30 CFR 250.197, 30 CFR 550.197, and 30 CFR 551.14.

Purpose: To process a refund request.

Routine Uses: The information on this form may be shared outside the DOI as follows: to the Department of Treasury to process payment information. More information about the routine uses can be found in system of records notice, Accounts Receivable: FBMS, DOI-86.

Disclosure: Providing the requested information is voluntary but if not provided we will not be able to process your request.


Refund requests will be processed within 6-8 weeks. Effective immediately, requests for ACH-debit refunds will be processed electronically; company bank account information is now required for all ACH-debit refunds. Once a refund request is approved, you will receive an email from BSEEFinanceAccountsReceivable@bsee.gov with an ACH/Paygov Refund Enrollment form to prepare and return for processing. When the enrollment form process is completed you will receive an another email from BSEEFinanceAccountsReceivable@bsee.gov that will provide you with a unique BSEE or BOEM FBMS (Financial Business Management System) Customer Number for your Company to use for all future Paygov ACH refund requests.

Please select the appropriate tab, either the credit card tab or the ACH tab, according to your original method of payment.


Application Name:*
v
Date of Original Payment:*
v
Agency Tracking ID:*
Pay.Gov Tracking ID:*
Contact Name:*
Name on Credit Card:*
Fee Amount Paid(US Dollars):*
E-Mail Address:*
Phone Number(including area code):*
Memo (reason requesting refund):*
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Application Name:*
v
Date of Original Payment:*
v
Agency Tracking ID:*
Pay.Gov Tracking ID:*
FBMS Customer Number:
(only use if you received an FBMS Customer Number)
Contact Name:*
Fee Amount Paid(US Dollars):*
Address Line 1:*
Address Line 2:
City:*
State:*
v
Zip:*
E-Mail Address:*
Phone Number(including area code):*
Memo (reason requesting refund):*
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Submit Request
 
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