Payment Plan Application Full Name Debtor Number/Agency Debt ID Last 4 Digits of SSN Your Address 1 Your Address 2 City State Zip Code Phone Number Your Email Address By providing my email address, I authorize ODR to communicate with me electronically regarding this account. Important Submission of this application does not guarantee approval of a payment plan. All requests are subject to review and approval by the Office of Debt Recovery. Debt Information Total Amount Owed (if known) Requested Payment Plan Requested Monthly Payment Amount Minimum Payment Requirement The required minimum monthly payment is: 5% of the outstanding balance OR $25.00, whichever is greater. (ODR may require a higher payment amount based on the total balance owed.) Acknowledgments and Terms By submitting this application, I understand and agree that: Approval of a payment plan is subject to review and approval by the Office of Debt Recovery (ODR). All payments must be made on time and in full. Failure to comply with the payment terms may result in enforcement action as permitted by law. State tax refunds and other eligible state payments may continue to be offset while a balance remains due, even if a payment plan is active. Payment plan agreements will be issued electronically unless otherwise required. Applicant Acknowledgment (Required) I acknowledge that I have read, understand, and agree to the terms and conditions listed above. Important Information About OMV Debt If your debt includes Office of Motor Vehicles (OMV) charges: An ODR payment plan does NOT remove a driver’s license suspension or vehicle registration block. You must establish a separate OMV installment agreement to clear suspensions or registration blocks. To set up an OMV payment plan or check your license status, visit: expresslane.org The numbers before the hyphen in your Original Account Number represent your Louisiana driver’s license number. You must continue making payments until OMV confirms your balance is paid in full. Missing OMV payments may result in additional fees, license suspension, or ineligibility for another OMV installment agreement. If you have other non-OMV debts with ODR, you may request an ODR payment plan for those accounts to prevent collection activity. Once your OMV installment agreement is active, contact ODR so payments may be applied appropriately.
