North Dakota ACH Credit Authorization

ACH Credit Authorization
Form 301-EF - ACH Credit Authorization
Form

301-EF

North Dakota Office of State Tax Commissioner

ACH Credit Authorization

Income Tax Withholding Only

FOR OFFICE USE ONLY

New ACH Credit
Change contact name/address
Change payroll service information

Please print. See reverse for instructions.
Section 1 - Taxpayer Information
1. Taxpayer Legal Name
2. Doing Business As Name (if different from line 1)
3. Mailing Address
4. City, State & Zip
5. Contact Person for E-File
6. E-Mail Address for Contact Person
7. Phone Number for Contact Person
8. State Withholding Account Number (Your 9-digit federal ID plus the State's 2-digit suffix)

Section 2 - Payroll Service Information

[

]

Complete this section only if a payroll service will be making your payments
or if you are a payroll service preparing this form for the taxpayer.

Payroll Service
*Name
Yourof9-digit
federal ID plus the State's 2-digit suffix

Contact Person

Mailing Address

Telephone Number for Contact Person

City, State & Zip

E-Mail Address for Contact Person

Section 3 - Taxpayer Signature
This form does not provide on-line access to your withholding account information. For on-line access, please see instructions. By signing below, I understand I
have requested permission to file withholding tax returns and remit payment electronically via an ACH credit transaction I must initiate through my bank. I have contacted
my bank and confirmed the bank can initiate ACH credit transactions that meet the State's requirements. I understand the ACH credit transaction must be in the NACHA
standards format using the TXP convention to facilitate the proper posting of the credit. I agree to follow the instructions set forth in the income tax withholding guideline
and on the reverse side of this form. I also understand by completing the Payroll Service Information Section, I have designated the Payroll Service to act as my authorized
representative in matters related to the filing of my withholding tax returns with the State, including the disclosure of confidential withholding tax information on file with
the State. Once I have been approved to file electronically using an ACH Credit, I will not receive a paper return from the State, and will be required to file and pay using
the ACH credit method for each tax period. This authorization to participate is in effect until it is terminated by either party.

Date:

Taxpayer's Signature:
(Authorized Officer or Individual)

Title:

Print Name:

Note: If this form is being completed by a Payroll Service on behalf of the taxpayer, the taxpayer's authorized signature
must be obtained for us to disclose information unless there is a Form 500 on file with our office.

Mail to:

Office of State Tax Commissioner
Business Registration
600 E. Boulevard Ave. Dept. 127
Bismarck, ND 58505-0599

Contact:

Phone: 701-328-1241
Fax: 701-328-0332
E-mail: [email protected]
Website: tax.nd.gov

301-EF Instructions
Employers must have an active income tax withholding account with the Office of State Tax
Commissioner before filing electronically. Go to www.tax.nd.gov/tap and select Apply for Sales
& Use or Withholding to obtain an account or to re-open an account.
Two methods are available to file income tax withholding returns electronically:
• Taxpayer Access Point (TAP) – Returns and payments are submitted online. TAP provides
access to online features that allow authorized users to view previously filed returns and
payments, upload or key W-2 information, change filing methods, and add or delete user’s
access. To register online go to www.tax.nd.gov/tap and sign up for access.
• ACH Credit (Withholding E-File) – An ACH Credit is an electronic transfer of funds
where you instruct your bank to transfer payment from your account to the state’s bank
account. The ACH Credit contains return information and, therefore, also serves as the
return. Registration may be completed by submitting this paper form. Registration using
this paper form does not provide you access to TAP to view previously filed returns. Tax
Payment Banking (TXP) addenda record layout is required for Income Tax Withholding
returns and is available at www.tax.nd.gov.
Helpful Hints for the Form
• Complete all questions to avoid any delay.
• The E-File contact person should be the person who will actually be involved in initiating
and making the electronic filing of your return. Be sure to include a phone number.
• If you are a Payroll Service completing the application on behalf of a taxpayer, be sure to
have the taxpayer sign and date the form at the bottom of Section 3.
o Exception: If a properly completed Form 500 Authorization to Disclose Tax
Information and Designation of Representative has been submitted by the taxpayer, no
signature is required.

28206 (January 2016)