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APPENDIX A—Model Disclosure Clauses and Forms

A-1—Model Clauses for Unsolicited Issuance (section 1005.5(b)(2))
A-2—Model Clauses for Initial Disclosures (section 1005.7(b))
A-3—Model Forms for Error Resolution Notice (sections 1005.7(b)(10) and 1005.8(b))
A-4—Model Form for Service-roviding Institutions (section 1005.14(b)(1)(ii))
A-5—Model Clauses for Government Agencies (section 1005.15(e)(1) and (2))
A-6—Model Clauses for Authorizing One-Time Electronic Fund Transfers Using Information from a Check (section 1005.3(b)(2))
A-7—Model Clauses for Financial Institutions Offering Prepaid Accounts (section 1005.18(d) and (e)(3))
A-8—Model Clause for Electronic Collection of Returned Item Fees (section 1005.3(b)(3))
A-9—Model Consent Form for Overdraft Services (section 1005.17)
A-10(a)—Model Form for Short Form Disclosures for Government Benefit Accounts (sections 1005.15(c) and 1005.18(b)(2), (3), (6), and (7))
A-10(b)—Model Form for Short Form Disclosures for Payroll Card Accounts (section 1005.18(b)(2), (3), (6), and (7))
A-10(c)—Model Form for Short Form Disclosures for Prepaid Accounts, Example 1 (section 1005.18(b)(2), (3), (6), and (7))
A-10(d)—Model Form for Short Form Disclosures for Prepaid Accounts, Example 2 (section 1005.18(b)(2), (3), (6), and (7))
A-10(e)—Model Form for Short Form Disclosures for Prepaid Accounts with Multiple Service Plans (section 1005.18(b)(2), (3), (6), and (7))
A-10(f)—Sample Form for Long Form Disclosures for Prepaid Accounts (section 1005.18(b)(4), (6), and (7))
A-11 through A-29 [Reserved]
A-30(a)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer where non-covered third-party fees and foreign taxes may apply (section 1005.31(b)(1))
A-30(b)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimate for non-covered third-party fees (section 1005.31(b)(1))
A-30(c)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimate for foreign taxes (section 1005.31(b)(1))
A-30(d)—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency, including a disclaimer with estimates for non-covered third-party fees and foreign taxes (section 1005.31(b)(1))
A-31—Model Form for Receipts for Remittance Transfers Exchanged into Local Currency (section 1005.31(b)(2))
A-32—Model Form for Combined Disclosures for Remittance Transfers Exchanged into Local Currency (section 1005.31(b)(3))
A-33—Model Form for Pre-Payment Disclosures for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(1))
A-34—Model Form for Receipts for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(2))
A-35—Model Form for Combined Disclosures for Dollar-to-Dollar Remittance Transfers (section 1005.31(b)(3))
A-36—Model Form for Error Resolution and Cancellation Disclosures (Long) (section 1005.31(b)(4))
A-37—Model Form for Error Resolution and Cancellation Disclosures (Short) (section 1005.31(b)(2)(iv) and (b)(2)(vi))
A-38—Model Form for Pre-Payment Disclosures for Remittance Transfers Exchanged into Local Currency
A-39—Model Form for Receipts for Remittance Transfers Exchanged into Local Currency—Spanish (section 1005.31(b)(2))
A-40—Model Form for Combined Disclosures for Remittance Transfers Exchanged into Local Currency—Spanish (section 1005.31(b)(3))
A-41—Model Form for Error Resolution and Cancellation Disclosures (Long)—Spanish (section 1005.31(b)(4))

Board of Governors of the Federal Reserve System

Federal Reserve Regulatory Service

APPENDIX A—Model Disclosure Clauses and Forms

Federal Reserve Regulatory Service

APPENDIX A—Model Disclosure Clauses and Forms

Supplementary Information