1.
Make the check payable to the "Pension Benefit Guaranty Corporation"
2. Enter the plan’s EIN, PN, Plan Year Commencement Date (if these are
not alreadypresent), and the amount of your check on this voucher.
3. Send this voucher and check to one of the following addresses:
By United States Postal Service:
Pension Benefit Guaranty Corporation
P.O. Box 979120
St. Louis, MO 63197-9000
OR Ove
rnight Delivery (e.g. FedEx, UPS, DHL):
U.S. Bank Government Lockbox
Attn: PBGC #979120
1005 Convention Plaza
St. Louis, MO 63101
Phone: 1-800-736-2444
EIN:
PN:
Plan Year Commencement Date:
Check Amount:
Please write the plan's EIN/PN and Plan Year Commencement Date on the paper
check in case the check becomes separated from the voucher.
Notice to Customers Making Payment by Check
Privacy Act – A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and
collecting
the information from your check, and explaining the purposes and routine uses which will be made of your
check information, is available from our internet site at (https://www.fms.treas.gov/otcnet/legl.html), or call toll free at
(1-866- 945-7920) to obtain a copy by mail. Furnishing the check information is voluntary, but a decision not to do so
may
require you to make payment by some other method.
When you provide a check as payment, you authorize us either to use information from your check to make a one-
time
electronic fund transfer from your account or to process the payment as a check transaction.
Alternatively, you also have the option to make an electronic payment on Pay.gov.
The preferred Pay.gov option is fast, secure and free for premium payers!
Notice from Bureau of the Fiscal Service, U. S. Department of the Treasury
My PAA Confirmation Number:
Due Date:
