Offshore Minerals Management Home Page

United States Department of the Interior

Content:
Marcia Oliver

Pagemasters:
OMM Web Team

Fees for Service Refund Request

Your refund request will be processed within 6-8 weeks. For ACH refunds, refund checks will be mailed to the address you provide below.

Instructions: Required Fields are marked with an asterisk (*).

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All fields in red indicate that invalid data has been entered in it.

*Identify method of original payment
ACH Credit Card

*Memo to MMS (reason requesting refund)


*Application Name:
*Date of Original Payment:
*Agency ID:
*Pay.Gov Tracking ID:
*Contact Name:
*Payee Name:
*Name on Credit Card:
Check Number:
*Original Transaction Date:
*Fee Amount Paid (US Dollars):
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip:
*Deposit Ticket Number:
*E-mail address:
*Phone Number (including area code):

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