Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 130 views

    Standard Form 1199A - Direct Deposit Sign-Up Form

    Uploaded by

    aiyi.wu
    This document is a direct deposit sign-up form that allows payees to provide their banking information to receive payments via direct deposit rather than check. It collects the payee's name, address, type of account and account number. The payee authorizes the financial institution to deposit payments from the specified government agency. The financial institution verifies the payee's information and account and certifies that it will receive payments according to government regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Standard Form 1199A - Direct Deposit Sign-Up Form

    Uploaded by

    aiyi.wu
    130 views1 page
    This document is a direct deposit sign-up form that allows payees to provide their banking information to receive payments via direct deposit rather than check. It collects the payee's name, address, type of account and account number. The payee authorizes the financial institution to deposit payments from the specified government agency. The financial institution verifies the payee's information and account and certifies that it will receive payments according to government regulations.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a direct deposit sign-up form that allows payees to provide their banking information to receive payments via direct deposit rather than check. It collects the payee's name, address, type of account and account number. The payee authorizes the financial institution to deposit payments from the specified government agency. The financial institution verifies the payee's information and account and certifies that it will receive payments according to government regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    130 views1 page

    Standard Form 1199A - Direct Deposit Sign-Up Form

    Uploaded by

    aiyi.wu
    This document is a direct deposit sign-up form that allows payees to provide their banking information to receive payments via direct deposit rather than check. It collects the payee's name, address, type of account and account number. The payee authorizes the financial institution to deposit payments from the specified government agency. The financial institution verifies the payee's information and account and certifies that it will receive payments according to government regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Standard Form 1199A OMB No.

    1530-0006
    (Rev. February 2020)

    DIRECT DEPOSIT SIGN-UP FORM


    Prescribed by Treasury Department
    Treasury Dept. Cir. 1076

    DIRECTIONS
    To sign up for Direct Deposit, the payee is to read the back of this form The claim number and type of payment are printed on Government
    and fill in the information requested in Sections 1 and 2. Then take or checks. (See the sample check on the back of this form.) This information
    mail this form to the financial institution. The financial institution will is also stated on beneficiary/annuitant award letters and other documents
    verify the information in Sections 1 and 2, and will complete Section from the Government agency.
    3. The completed form will be returned to the Government agency
    identified below. Payees must keep the Government agency informed of any address
    changes in order to receive important information about benefits and to
    A separate form must be completed for each type of payment to be sent remain qualified for payments.
    by Direct Deposit.
    SECTION 1 (TO BE COMPLETED BY PAYEE)
    A NAME OF PAYEE (last, first, middle initial) D TYPE OF DEPOSITOR ACCOUNT CHECKING SAVINGS

    E DEPOSITOR ACCOUNT NUMBER


    ADDRESS (street, route, P.O. Box, APO/FPO)

    CITY STATE ZIP CODE F TYPE OF PAYMENT (Check only one)


    Social Security Fed. Salary/Mil. Civilian Pay
    TELEPHONE NUMBER Supplemental Security Income Mil. Active
    AREA CODE Railroad Retirement Mil. Retire.
    Civil Service Retirement (OPM) Mil. Survivor
    B NAME OF PERSON(S) ENTITLED TO PAYMENT VA Compensation or Pension Other
    (specify)

    C CLAIM OR PAYROLL ID NUMBER G THIS BOX FOR ALLOTMENT OF PAYMENT ONLY(if applicable)
    TYPE AMOUNT
    Prefix Suffix
    PAYEE/JOINT PAYEE CERTIFICATION JOINT ACCOUNT HOLDERS’ CERTIFICATION
    I certify that I am entitled to the payment identified above, and that I have I certify that I have read and understood the back of this form, including
    read and understood the back of this form. In signing this form, I authorize the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.
    my payment to be sent to the financial institution named below to be
    deposited to the designated account.
    SIGNATURE DATE SIGNATURE DATE

    SIGNATURE DATE SIGNATURE DATE

    SECTION 2 (TO BE COMPLETED BY PAYEE OR FINANCIAL INSTITUTION)


    GOVERNMENT AGENCY NAME GOVERNMENT AGENCY ADDRESS

    SECTION 3 (TO BE COMPLETED BY FINANCIAL INSTITUTION)


    NAME AND ADDRESS OF FINANCIAL INSTITUTION ROUTING NUMBER CHECK
    DIGIT

    DEPOSITOR ACCOUNT TITLE

    FINANCIAL INSTITUTION CERTIFICATION

    I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial institution, I certify
    that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210.

    PRINT OR TYPE REPRESENTATIVE’S NAME SIGNATURE OF REPRESENTATIVE TELEPHONE NUMBER DATE

    Financial institutions should refer to the GREEN BOOK for further instructions.
    THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE. Reset
    GOVERNMENT AGENCY COPY 1199-207

    You might also like