- Standard Form 1199A at a glance
- A filled-in Standard Form 1199A example: a payee signs up for Social Security direct deposit into a checking account
- How to fill out Standard Form 1199A, box by box
- More rules for Standard Form 1199A
- Death, cancellation, a change of financial institution and false statements
- Common questions about Standard Form 1199A
- Sources
Standard Form 1199A at a glance
What it is: Standard Form 1199A is the Direct Deposit Sign-Up Form, prescribed by the Treasury Department. 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.
Section 1 is to be completed by the payee.
Section 2 is to be completed by the payee or the financial institution.
Section 3 is to be completed by the financial institution.
After the payee fills in Sections 1 and 2, the payee is to 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 in Section 2.
A filled-in Standard Form 1199A example: a payee signs up for Social Security direct deposit into a checking account
How to fill out Standard Form 1199A, box by box
Tap a group of boxes to open it, and a picture to see it full size.
Box A, in Section 1: the payee's name, address and telephone number
Most of the information needed to complete boxes A, C, and F in Section 1 is printed on your government check.
Box A, Name of Payee: write the last name, the first name and the middle initial.
Be sure that the payee's name is written exactly as it appears on the Government check.
Address: write the street, route, P.O. Box or APO/FPO address.
Be sure current address is shown.
City, State and Zip Code: fill in the city, the state and the ZIP code.
Telephone Number: write the telephone number with its AREA CODE.
Boxes B and C: person entitled to payment, claim or payroll ID number
Box B, Name of Person(s) Entitled to Payment: write the name of the person or persons entitled to payment.
Box C, Claim or Payroll ID Number: write the number; the box also has lines for a Prefix and a Suffix.
The claim number and type of payment are printed on Government checks (see the sample check on the back of this form).
The claim number and type of payment are also stated on beneficiary/annuitant award letters and other documents from the Government agency.
Check the Green Book for the location of prefixes and suffixes for other types of payments.
Boxes D and E: type of depositor account and account number
Box D, Type of Depositor Account: mark CHECKING or SAVINGS.
Box E, Depositor Account Number: write the account number.
Boxes F and G: type of payment and allotment of payment
Box F, Type of Payment: check only one of Social Security, Supplemental Security Income, Railroad Retirement, Civil Service Retirement (OPM), VA Compensation or Pension, Fed. Salary/Mil. Civilian Pay, Mil. Active, Mil. Retire., Mil. Survivor, or Other (specify).
Common mistake: A separate form must be completed for each type of payment to be sent by Direct Deposit.
On a Government check, the type of payment is printed to the left of the amount.
Box G, Type and Amount: this box is for allotment of payment only (if applicable).
Section 1 certifications, signatures and dates
PAYEE/JOINT PAYEE CERTIFICATION: the payee or joint payee who signs certifies that they are entitled to the payment identified in Section 1 and that they have read and understood the back of this form.
By signing, the payee or joint payee authorizes the payment to be sent to the financial institution named in Section 3 to be deposited to the designated account.
JOINT ACCOUNT HOLDERS' CERTIFICATION: the joint account holder who signs certifies that they have read and understood the back of this form, including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.
Each certification has two lines for a SIGNATURE, and each signature line has a DATE.
Section 2, to be completed by the payee or the financial institution: the Government agency
Government Agency Name and Address: write the name and the address of the Government agency.
Section 3, to be completed by the financial institution
Name and Address of Financial Institution: write the name and the address of the financial institution.
Routing Number and Check Digit: write the routing number and the check digit.
Depositor Account Title: write the depositor account title.
FINANCIAL INSTITUTION CERTIFICATION: the representative of the financial institution confirms the identity of the payee or payees named in Section 1 and the account number and title, and certifies that the financial institution agrees to receive and deposit the payment identified in Section 1 in accordance with 31 CFR Parts 240, 208, and 210.
Print or type the representative's name, sign under SIGNATURE OF REPRESENTATIVE, and fill in the TELEPHONE NUMBER and the DATE.
Financial institutions should refer to the GREEN BOOK for further instructions.
More rules for Standard Form 1199A
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.
All information on this form, including the individual claim number, is required under 31 USC 3322, 31 CFR 209 and/or 210.
Failure to provide the requested information may affect the processing of this form and may delay or prevent the receipt of payments through the Direct Deposit/Electronic Funds Transfer Program.
Death, cancellation, a change of financial institution and false statements
Death of a beneficiary
Joint account holders (JOINT ACCOUNT HOLDERS' CERTIFICATION, Section 1) should immediately advise both the Government agency and the financial institution of the death of a beneficiary.
Funds deposited after the date of death or ineligibility, except for salary payments, are to be returned to the Government agency.
The Government agency will then make a determination regarding survivor rights, calculate survivor benefit payments, if any, and begin payments.
Changing receiving financial institutions
The payee's Direct Deposit will continue to be received by the selected financial institution until the Government agency is notified by the payee that the payee wishes to change the financial institution receiving the Direct Deposit.
To effect this change, the payee will contact the paying agency with updated financial information.
It is recommended that the payee maintain accounts at both financial institutions until the transaction is complete, i.e. after the new financial institution receives the payee's Direct Deposit payment.
False statements or fraudulent claims
Federal law provides a fine of not more than $10,000 or imprisonment for not more than five (5) years or both for presenting a false statement or making a fraudulent claim.
Common questions about Standard Form 1199A
Where to send standard form 1199A?
After the payee fills in Sections 1 and 2, the payee is to take or mail this form to the financial institution. The financial institution should mail the completed form to the Government agency identified in Section 2.
What is an SF 1199A form?
Standard Form 1199A is the Direct Deposit Sign-Up Form, prescribed by the Treasury Department.
What do I put under the amount for direct deposit?
Box G, Type and Amount: this box is for allotment of payment only (if applicable).
Sources
[1] Standard Form 1199A (Rev. October 2024), Direct Deposit Sign-Up Form, prescribed by the Treasury Department (the Official source link on this page).