Standard Form 1199 A PDF Details

In navigating the complexities of direct deposit for government payments, the Standard Form 1199A embodies a crucial tool for both recipients and financial institutions. Crafted by the Treasury Department and enhanced by Treasury Dept. Cir. 1076, this form serves as a gateway for individuals to securely and efficiently receive various types of federal payments -- from federal salaries and military pay to Social Security benefits and more -- directly into their bank accounts. Its inception, marked by the directive of OMB No. 1510-0007, reflects a strategic move towards optimizing financial transactions through automation. The process, as outlined, involves a detailed reciprocation of information where recipients are required to furnish pertinent details about their bank accounts, alongside the specific category of government payments they are entitled to. This step is then followed by validation from the financial institution, which completes the linkage and ensures that the designated government agency is apprised. Moreover, the emphasis on an individualized form for each distinct payment type underscores a tailored approach to direct deposit sign-ups. The necessity for recipients to remain communicative about address changes further underscores the importance of seamless information flow to uphold benefit eligibility and uninterrupted payment reception. Additionally, the provision for joint account holders to attest to their understanding and consent introduces an additional layer of verification, securing the integrity of the direct deposit process. Thus, Standard Form 1199A stands as a testament to modern financial procedural efficiency, reinforcing the mutual benefits attainable through direct deposit mechanisms in a governmental context.

QuestionAnswer
Form NameStandard Form 1199 A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDirect Deposit Fillable Form direct deposit nrotc form

Form Preview Example

Standard Form 1199A (EG)

(Rev. June 1987) Prescribed by Treasury Department Treasury Dept. Cir. 1076

OMB No. 1510-0007

DIRECT DEPOSIT SIGN-UP FORM

•To sign up for Direct Deposit, the payee is to read the back of this form and fill in the information requested in Sections 1 and 2. Then take or mail this form to the financial institution. The financial institution will verify the information in Sections 1 and 2, and will complete Section 3. The completed form will be returned to the Government agency Identified below.

•A separate form must be completed for each type of payment to be sent by Direct Deposit.

DIRECTIONS

•The claim number and type of payment are printed on Government checks. (See the sample check on the back of this form.) This information is also stated on beneficiary/annuitant award letters and other documents from the Government agency.

•Payees must keep the Government agency informed of any address changes in order to receive important information about benefits and to remain qualified for payments.

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)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fed. Salary/Mil. Civilian Pay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security

 

 

 

 

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Supplemental Security Income

 

 

 

 

Mil. Active

______________

 

 

AREA CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Railroad Retirement

 

 

 

 

Mil. Retire. ______________

 

B NAME OF PERSON(S) ENTITLED TO PAYMENT

 

 

 

 

Civil Service Retirement (OPM)

 

 

 

 

Mil. Survivor_____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 (optional)

 

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.

NSN 7540-01-058-0224

GOVERNMENT AGENCY COPY

199-207

Designed using Perform Pro, WHS/DIOR, Mar 97

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2. Once your current task is complete, take the next step – fill out all of these fields - SECTION TO BE COMPLETED BY, NAME AND ADDRESS OF FINANCIAL, ROUTING NUMBER CHECK DIGIT, I confirm the identity of the, FINANCIAL INSTITUTION CERTIFICATION, PRINT OR TYPE REPRESENTATIVES NAME, SIGNATURE OF REPRESENTATIVE, TELEPHONE NUMBER DATE, DEPOSITOR ACCOUNT TITLE, THE FINANCIAL INSTITUTION SHOULD, NSN GOVERNMENT AGENCY COPY, Financial institutions should, and Designed using Perform Pro WHSDIOR with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

ROUTING NUMBER CHECK DIGIT, SECTION TO BE COMPLETED BY, and THE FINANCIAL INSTITUTION SHOULD in Standard Form 1199 A

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