Form 12711 – Fill Out and Use This PDF

The Form 12711 serves a crucial function by collecting essential address and salary check mailing information from employees when the Employee Express System is unavailable. This document facilitates seamless interactions between personnel, payroll systems, and employees, ensuring timely and accurate deliveries of important payroll documentation. For instances where an immediate update is required and Employee Express cannot be accessed, this form provides a vital alternative. Ready to update your information? Click the button below to fill out your Form 12711.

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Form 12711 PDF Details

In an organizational ecosystem where accuracy in personnel records is paramount, the Form 12711 emerges as a critical tool, especially when the convenience of digital platforms like Employee Express is not accessible. This form, titled "Employee Address Information for Personnel/Payroll System," serves a dual purpose: it is instrumental in capturing an employee's home address along with designating the preferred address for the mailing of salary checks, thus ensuring the seamless processing of payroll. Particularly designed for employees who are currently on the roster, furloughed, or recently separated from the organization, it necessitates the completion of specific sections to cater to different needs - encompassing everything from direct deposit elections to the provision of a mailing address for those opting out of direct deposit. The nuances of completing the form - from the mandatory inclusion of a Social Security Number as sanctioned under Public Law 93-579 for identification purposes to following the strict guidance outlined for items 1-6 and 18-19 - underscore its importance in maintaining up-to-date records. Moreover, with detailed instructions for employees residing in Puerto Rico and directives regarding direct deposit sign-up, the Form 12711 encapsulates essential processes within Federal employment management. The provision for additional clarifications via the Employee Resource Center and the outlined return procedures signify the form's role in streamlining employee information updates, thereby highlighting the interconnectedness of administrative efficiency and employee satisfaction.

Question	Answer
Form Name	Form 12711
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	1974, Urbanization, irs salary, Rico

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Employee Address Information for Personnel/Payroll System

The purpose of this form is to obtain an employee's home address and/or salary check mailing address, when the Employee Express System is not available for use. Employees on rolls should use Employee Express to change their address information.

Employee Express

on-line From Work or Home

www.employeeexpress.gov

Employee Express by Phone

From Work 478-757-3085	From Home 800-827-6290
(TTY/TDD 478-757-3117)	(TTY/TDD 888-880-0412)

For all Requests Complete Items 1-6 and 18-19.

1. Work Phone (Include area code)			2. Home Phone (Include area code)				3.	Tour of Duty
(	)	-	(	)	-			am	to	am
(	)	-	(	)	-			pm	to	pm
								pm		pm

4. Name (Last, First, Middle Initial)							5.	Social Security Number
			,			,		-	-

6. Employee Status (check one)

On Rolls

Furloughed

Separated

Date Separated (mm/dd/yyyy)	/		/

New Address

Establish or Change Your Residence Address by Completing Items 7-12 & 18-19.

7.Urbanization (Puerto Rico only)

8. Street Address or P.O. Box

9. City

10. County

11. State

12.Zip Code + 4

New employees must complete an SF-1199A, Direct Deposit Sign-Up Form, to have your salary check direct deposited to your bank. If you do not elect to have your salary Direct Deposited, please provide a salary check mailing address in the section below.

Direct Deposit

I am electing Direct Deposit		I am NOT signing up for Direct Deposit.
(Skip to Item 18)		(Complete Items 13-19 below.)

	Salary Check	If you did not elect for Direct Deposit of your salary check, you must provide a mailing
Mailing Address		address below to receive your check through the U.S. mail.

13.	Urbanization (Puerto Rico only)			14.	Street Address or P. O. Box

15.	City			16.	State	17. Zip Code + 4
						-

			Agency Use Only

City Code

County

State Code

Questions regarding this form should be directed to:

the Employee Resource Center (ERC) at 1-866-743-5748, Option 1 (TTY/TDD 1-866-924-3578).

Return this completed form to: IRS Payroll Center; Drop Point B-5721, P.O. Box 245, Bensalem, PA 19020

18. Employee Signature

19. Date (mm/dd/yyyy)

X		/	/
		/	/

Form 12711 (Rev. 3-2005)	Catalog Number 29736N	Department of the Treasury - Internal Revenue Service
		http://publish.no.irs.gov

Privacy Act Notice

General

This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals completing Form 12711.

Authority

5 USC 301

Purpose and Uses

This form is used to obtain an employee's home address.

Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b) (Privacy Act of 1974)

Disclosure by you of your Social Security Number (SSN) is mandatory to obtain the services, benefits, or process that you are seeking. Solicitation of the SSN by the United States Department of Agriculture is authorized under provisions of Executive Order 9397, Date November 22, 1943. The SSN is used as an identifier throughout your Federal career from the time of application through retirement. It will be used primarily to identify your records that you file with the U. S. Department of Agriculture. The SSN also will be used by the U. S. Department of Agriculture and other Federal agencies in connection with lawful requests for information about you from your former employers, educational institutions, and financial or other organizations. The information gathered through the use of the number will be used only as necessary in personnel administration process carried out in accordance with established regulations and published notices of systems of records. The SSN also will be used for the selection of persons to be included in statistical studies of personnel management matters. The use of the SSN is made necessary because of the large number of present and former Federal employees and applicants who have identical names and birth dates, and those identities can only be distinguished by the SSN.

Form 12711 (Rev. 3-2005)

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2. Once your current task is complete, take the next step – fill out all of these fields - Urbanization Puerto Rico only, Street Address or P O Box, City, State, Zip Code, City Code, County, State Code, Agency Use Only, Questions regarding this form, the Employee Resource Center ERC, Return this completed form to, IRS Payroll Center Drop Point B PO, Employee Signature, and X Form Rev with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

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Form 12711 – Fill Out and Use This PDF

Form 12711 PDF Details

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