Agency name and statement
(AGENCY NAME) at the top, then the Paperwork Reduction Act/Privacy Act Statement citing the Electronic Fund Transfer Act (15 USC § 1693 et seq.), 12 CFR 205, and 31 CFR 206 and 210.
SF5510
Authorization Agreement for Preauthorized Payments
- Agency
- GSA
- Revision
- Rev. 3/2017
- Fillable fields
- 24
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 5510 (SF 5510): Authorization Agreement for Preauthorized Payments
Standard Form 5510 (SF 5510), Authorization Agreement for Preauthorized Payments, is a Department of the Treasury form. Its footer reads DEPARTMENT OF THE TREASURY and STANDARD FORM 5510 (REV. 3/2017), prescribed by 12 CFR 205 and 31 CFR 206 and 210. GSA hosts a copy in its forms library.
The form's Paperwork Reduction Act/Privacy Act Statement says the information is requested for the purpose of authorizing the Department of the Treasury to electronically collect payments from your account, and that no pre-authorized electronic fund transfer may be transacted unless a signed authorization form is received. The agency's name goes at the top, followed by a start, change or stop choice, the individual or company section with the payer's signature, and the financial institution section.
The form prints OMB Control Number: 1530-0015 with Expiration Date: 6/30/2020 and estimates approximately 15 minutes to complete it. You can fill it out free in your browser on this page and download the result without an account.
What's on SF 5510
Start, change or stop
A CHECK ONE row with START, CHANGE and STOP boxes.
Individual or company information
Name (please print), street address, city/state, ZIP code, area code and telephone number, your agency account identification number and type of payment.
Authorization and signature
A paragraph authorizing debit entries from the account listed and the financial institution named to debit it, followed by SIGNATURE and DATE.
Financial institution information
Institution name, street address, city/state, ZIP code, nine-digit routing transit number, account title, account number, and checking or savings.
Representative's signature
SIGNATURE AND TITLE OF REPRESENTATIVE, AREA CODE/TELEPHONE NUMBER and DATE.
The single page runs from the agency name at the top to the representative's signature at the bottom.
How to complete SF 5510
- 1
Enter the agency name
Write the name of the agency to be paid on the (AGENCY NAME) line at the top.
- 2
Check start, change or stop
Mark one box in the CHECK ONE row: START, CHANGE or STOP.
- 3
Fill in the payer details
Print the individual or organization name, the address and telephone, your agency account identification number and the type of payment.
- 4
Read and sign the authorization
The paragraph says you will be notified if the debit amount needs to be adjusted, and describes stopping automatic payment by notifying your financial institution in writing three days prior to the charge. Sign and date it.
- 5
Add the bank details
Enter the financial institution's name and address, the nine-digit routing transit number, the account title and number, and check checking or savings.
- 6
Institution representative signs
The financial institution section ends with the signature and title of a representative, an area code and telephone number, and a date.
The form prints no step-by-step instructions. These steps follow its sections.
Why fill Form SF5510 on indox
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Where it goes and what the form says
Where it goes
The PDF prints no mailing address. The authorization refers to the agency listed at the top, which receives written notification to end it.
Stopping payments
The form says you have the right to stop automatic payment by notifying your financial institution in writing three days prior to the time your account is to be charged.
How long it lasts
The form says the authorization remains in full force and effect until the agency listed has received written notification, in time and manner to give the agency and the financial institution a reasonable opportunity to act on it.
OMB number and time
OMB Control Number: 1530-0015, Expiration Date: 6/30/2020. The form estimates it will take approximately 15 minutes to complete.
Edition and copies
The footer says PREVIOUS EDITION NOT USABLE and AUTHORIZED FOR LOCAL REPRODUCTION.
Related forms
Who fills out SF 5510?
The form has a section for the payer and a section for the financial institution, under the name of the agency being paid.
Official sources and the blank
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Questions about Form SF5510
Who issues SF 5510?
The footer reads DEPARTMENT OF THE TREASURY and STANDARD FORM 5510 (REV. 3/2017), prescribed by 12 CFR 205 and 31 CFR 206 and 210. GSA hosts a copy in its forms library.
What is SF 5510 used for?
The form says the information is requested for the purpose of authorizing the Department of the Treasury to electronically collect payments from your account, and is used to match the agency's records with those of the financial institution.
Is filling out SF 5510 voluntary?
The form says furnishing the information is voluntary, but failure to furnish it may delay or prevent the electronic collection of a payment through the Automated Clearing House.
How are payments stopped?
The form says you have the right to stop automatic payment by notifying your financial institution in writing three days prior to the time your account is to be charged. It also has a STOP box in the CHECK ONE row.
Can the debit amount change?
The authorization says you will be notified if the debit amount needs to be adjusted, either to be increased or decreased.
Who signs SF 5510?
The individual or organization signs and dates the authorization. The financial institution section has a line for the signature and title of a representative.
How long does SF 5510 take to fill out?
The form estimates it will take approximately 15 minutes to complete.