Form Ssa 1199 Cn PDF Details

Ensuring beneficiaries of United States Social Security receive their monthly benefits efficiently and securely, the SSA-1199-CN form plays a pivotal role for Canadian residents. This form, a direct deposit sign-up document specifically devised for Canada, facilitates the transfer of U.S. Social Security payments directly into the beneficiaries' bank accounts, denominated in either Canadian or U.S. dollars. The process encapsulated in the form is quite straightforward but profoundly significant; beneficiaries are required to fill out their personal details and have their bank complete the relevant section to accurately route the payments. A particularly notable feature of this form is its accommodation for both individual and joint account holders, with clear provisions and certifications to safeguard the interests of all parties involved. Additionally, the form encapsulates crucial information about currency conversion, highlighting the automatic process of converting U.S. Social Security payments to the desired currency at the prevailing international exchange rate. However, the responsibility does not end upon submitting the form; beneficiaries must proactively report any changes such as alterations in banking details or addresses to prevent disruptions. The privacy and use of personal information provided through this form are protected under the Privacy Act, ensuring confidentiality and restricted use of the data solely for processing benefit payments and other authorized purposes. The SSA-1199-CN form, therefore, serves as a vital conduit for Canadian residents, ensuring the seamless and secure receipt of their U.S. Social Security benefits.

QuestionAnswer
Form NameForm Ssa 1199 Cn
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesdirect deposit sign up canada form, ssa 1199 deposit sign up direct, ssa 1199 sign up, ssa to change direct deposit

Form Preview Example

Form SSA-1199-CN (04-2020)

Page 1 of 3

Discontinue Prior Editions

Social Security Administration

OMB No. 0960-0686

DIRECT DEPOSIT SIGN-UP FORM (CANADA)

APPLICATION FOR PAYMENT OF UNITED STATES SOCIAL SECURITY

MONTHLY BENEFITS BY DIRECT DEPOSIT

•Complete Section 1 and "SIGN YOUR NAME"

•Ask your bank to complete Section 3

•Mail completed form back using address in Section 2

 

SECTION 1 (TO BE COMPLETED BY PAYEE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Complete Mailing Address:

 

 

 

SOCIAL SECURITY CLAIM NUMBER

 

 

B.I.C.

 

 

 

 

 

(OPTIONAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Person Entitled to the Benefits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number:

 

 

 

THIS BOX IS FOR ALLOTMENT OF PAYMENT ONLY (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE CERTIFICATION

 

JOINT ACCOUNT HOLDER'S CERTIFICATION (optional)

I (beneficiary or representative payee) certify that I have read

I certify that I have read and understand the back of this form,

and understand the back of this form. In signing this form, I

including the SPECIAL NOTICE TO JOINT ACCOUNT

authorize the Social Security Administration to send this payment

HOLDERS.

 

 

 

 

 

 

 

 

to the financial institution indicated in Section 3 and deposit it in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the designated account. I understand that personal information in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

these payments is confidential, but I consent to disclosure of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

payment information compelled by law or necessary to protect

 

 

 

 

 

 

 

 

 

 

 

 

 

 

against fraud or crime.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Signature

 

Date

 

Joint Account Holder's Signature

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you the Representative Payee?

 

Yes

No

This account is:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My own account

A joint account

 

 

 

 

Beneficiary Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2 (MAILING ADDRESS)

 

 

 

 

 

 

 

 

GOVERNMENT AGENCY NAME:

SOCIAL SECURITY ADMINISTRATION

MAIL COMPLETED FORMS TO:

Social Security Administration

Office of Earnings and International Operations

Division of International Operations

PO Box 17769

Baltimore, MD 21235-7769

USA

SECTION 3 (TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION)

THIS ACCOUNT MUST BE IN CANADIAN DOLLARS OR U.S.DOLLARS

NAME OF BANK

BANK PHONE NUMBER

ADDRESS OF BANK

PRINT NAME OF BANK OFFICIAL

SIGNATURE OF BANK OFFICIAL

Canadian Dollar:

Checking

Savings

U.S. Dollar:

Checking

Savings

To have your benefits sent to a U.S. dollar account, have your bank complete section 3.A. or 3.B. To have your benefits sent to a Canadian Dollar account, have your bank complete section 3.C.

A. U.S. dollar account at Royal Bank of Canada: RTN: 026004093

Transit Number: (5 digits, begins with zero)

Account Number: (Must be 7 digits, begins with 4 or 8, no dash)

B. U.S. dollar account at any other financial institution in Canada: RTN: 62 Transit Number:

Institution Number:

Account Number:

C. Canadian dollar account at any financial institution in Canada: RTN: 51 Transit Number:

Institution Number:

Account Number:

ALL: No dashes, except Caisse Populaire 815 & 829 before 7th digit, 865 before 6th digit (which is always 2). POMS GN 02402.300

Form SSA-1199-CN (04-2020)

Page 2 of 3

IMPORTANT INFORMATION - PLEASE READ CAREFULLY

The information you give on this form is confidential. We need the information to send your U.S. Social Security payments electronically to your Canada bank account.

WHEN YOU WILL RECEIVE YOUR DIRECT DEPOSIT PAYMENTS

You will receive your payment through the Canada banking system and will usually be in your bank account shortly after the regular payment date. With direct deposit, you will have immediate access to your money. This is the safest way of receiving your benefits.

INFORMATION ABOUT CURRENCY CONVERSION:

With direct deposit, your U.S. Social Security payment is automatically converted to Canadian Dollars or U.S. Dollars (if applicable) at the daily international exchange rate before being deposited to your account.

**SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS**

If you have a joint account with a person who receives Social Security payments, and that person dies, you must immediately contact your bank and the Social Security Administration or the Federal Benefits Unit in your area. You must return to Social Security any payments deposited into a joint account after the death of a beneficiary.

IF YOUR ADDRESS CHANGES:

If your address changes, you must inform the Federal Benefits Unit or the Social Security Administration. Your payments may stop if the Social Security Administration needs to contact you and cannot find your location.

CHANGING BANKS OR BANK ACCOUNTS:

If you change your bank or your account, you must notify the following office:

Social Security Administration

Office of Earnings and International Operations

Division Of International Operations

PO Box 17769

Baltimore, MD

21235-7769

USA

You may need to fill out a new Direct Deposit sign-up form.

Do not close your old account until payments have started coming to your new account.

Form SSA-1199-CN (04-2020)

Page 3 of 3

 

 

 

Privacy Act Statement

 

Collection and Use of Personal Information

Section 205(a) of the Social Security Act, as amended, allows us to collect this information. Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent you from receiving benefit payments through foreign financial institutions.

We will use the information you provide to process benefit payments with your financial institution. We may also share your information for the following purposes, called routine uses:

•To the Department of State and its agents for administering the Act in foreign countries through facilities and services of that agency; and

•To third party contacts where necessary to establish or verify information provided by representative payees or payee applicants.

In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.

A list of additional routine uses is available in our Privacy Act System of Records Notices (SORN) 60-0089, entitled Claims Folders Systems, as published in the Federal Register (FR) on April 1, 2003, at 68 FR 15784 and 60-0090, entitled Master Beneficiary Record, as published in the FR on January 11, 2006, at 71 FR 1826. Additional information and a full listing of all our SORNs are available on our website at https://www.ssa.gov/privacy.

Paperwork Reduction Act Statement

This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and answer the questions.

SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are also listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

How to Edit Form Ssa 1199 Cn Online for Free

ssa 1199 sign up can be completed without any problem. Just try FormsPal PDF tool to accomplish the job in a timely fashion. To make our tool better and less complicated to utilize, we constantly develop new features, with our users' feedback in mind. Starting is easy! All you should do is follow these basic steps down below:

Step 1: Open the PDF form inside our editor by clicking on the "Get Form Button" in the top section of this page.

Step 2: Using our online PDF editing tool, it is possible to accomplish more than simply fill in blank fields. Try all of the features and make your docs appear sublime with custom text incorporated, or fine-tune the file's original input to excellence - all supported by the capability to incorporate any graphics and sign it off.

As for the fields of this precise form, here is what you need to do:

1. It is critical to fill out the ssa 1199 sign up accurately, so pay close attention when filling in the parts including all these blanks:

Step # 1 of filling out direct deposit change form ssa

2. Once your current task is complete, take the next step – fill out all of these fields - SECTION TO BE COMPLETED BY YOUR, BANK PHONE NUMBER, NAME OF BANK, ADDRESS OF BANK, PRINT NAME OF BANK OFFICIAL, SIGNATURE OF BANK OFFICIAL, Checking, Checking, Savings, Canadian Dollar To have your, B US dollar account at any other, C Canadian dollar account at any, Savings, US Dollar, and Account Number Must be digits with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage no. 2 of completing direct deposit change form ssa

People who use this PDF often make mistakes while completing Canadian Dollar To have your in this area. You should definitely read twice everything you type in here.

Step 3: Prior to obtaining the next step, make certain that all blanks were filled out right. The moment you verify that it is good, click “Done." Join us right now and immediately gain access to ssa 1199 sign up, ready for download. Each and every change made is conveniently preserved , making it possible to modify the form at a later point if required. We don't sell or share the information you use while filling out forms at our website.

Form Ssa 1199 Cn isn’t the one you’re looking for?

Related Documents