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Prepaid model forms and samples

Download Prepaid model and sample forms.

Print and source code versions of the forms are provided on the Bureau’s Prepaid GitHub page.

Description English Spanish translation of Form

Model Form A-10(a): Short Form Disclosures for Government Benefit Accounts
 (§ 1005.15(c) and § 1005.18(b)(2), (3), (6), and (7)) 

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Model Form A-10(b): Short Form Disclosures for Payroll Card Accounts
 (§ 1005.18(b)(2), (3), (6), and (7)) 

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Model Form A-10(c): Short Form Disclosures for Prepaid Accounts, Example 1
 (§ 1005.18(b)(2), (3), (6), and (7)) 

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Model Form A-10(d):  Short Form Disclosures for Prepaid Accounts, Example 2
 (§ 1005.18(b)(2), (3), (6), and (7)) 

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Model Form A-10(e): Short Form Disclosures for Prepaid Accounts with Multiple Service Plans
  (§ 1005.18(b)(2), (3), (6), and (7)) 

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Sample Form A-10(f): Long Form Disclosures for Prepaid Accounts
 (§ 1005.18(b)(4), (6), and (7)) 

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