Standard 1199A Direct Deposit PDF Form - FormsPal

Standard Form 1199A Direct Deposit PDF Details

Have you ever had to wait for a check in the mail? It's always a hassle, especially if you're waiting on it to pay bills or cover other expenses. With standard form 1199A direct deposit, though, you can avoid all of that hassle. This convenient system allows you to have your paycheck deposited directly into your bank account, so you can access your money right away. Plus, there's no need to worry about losing track of a check or forgetting to cash it - with direct deposit, the money goes straight into your account and is ready when you are.

You could find it beneficial to know the amount of time you will need to fill out this standard form 1199a direct deposit and exactly how long the form is.

Question	Answer
Form Name	Standard Form 1199A Direct Deposit
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	1199a direct deposit form usaa, voided check usaa, usaa bank authorization form, usaa direct deposit form 1199a

12

Form Preview Example

SECTION 1 (TO BE COMPLETED BY PAYEE)

Standard Form 1199A	OMB No. 1530-0006
(Rev. February 2020)

Treasury Dept. Cir. 1076	DIRECT DEPOSIT SIGN-UP FORM
Prescribed by Treasury Department
	DIRECTIONS

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.

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.

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.
				Reset
THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.				Reset
	GOVERNMENT AGENCY COPY
	GOVERNMENT AGENCY COPY			1199-207

SECTION 1 (TO BE COMPLETED BY PAYEE)

Standard Form 1199A	OMB No. 1530-0006
(Rev. February 2020)

Treasury Dept. Cir. 1076	DIRECT DEPOSIT SIGN-UP FORM
Prescribed by Treasury Department
	DIRECTIONS

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.

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.

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.

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

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.
				Reset
THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.				Reset
	FINANCIAL INSTITUTION COPY			1199-207

SECTION 1 (TO BE COMPLETED BY PAYEE)

Standard Form 1199A	OMB No. 1530-0006
(Rev. February 2020)

Treasury Dept. Cir. 1076	DIRECT DEPOSIT SIGN-UP FORM
Prescribed by Treasury Department
	DIRECTIONS

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.

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.

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

Supplemental Security Income

Mil. Active

TELEPHONE NUMBER

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.			Reset
	THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.			Reset

		PAYEE COPY		1199-207

SF 1199A (Back)

BURDEN ESTIMATE STATEMENT

The estimated average burden associated with this collection of information is 10 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimates and suggestions for reducing this burden should be directed to the Bureau of the Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328.

PRIVACY ACT NOTICE

Collection of the information in this Direct Deposit Sign-Up Form is authorized by 5 U.S.C. § 552a, 31 U.S.C. § 3332(g), and Executive Order 9397 (November 22, 1943). Your social security number and the other information requested will allow the Federal Government to process your direct deposit. Your social security number is requested to ensure the accurate identification and retention of records pertaining to you and to distinguish you from other recipients of federal payments. This information will be disclosed to the Department of the Treasury and its fiscal and financial agents, and other federal agencies, as necessary to process your direct deposit. This information may also be disclosed to a court, congressional committee

or another government agency as authorized or required to verify your receipt of federal payments. Although providing the requested information is voluntary, your direct deposit cannot be processed without it.

PLEASE READ THIS CAREFULLY

All information on this form, including the individual claim number, is required under 31 USC 3322, 31 CFR 209 and/ or 210. The information is confidential and is needed to prove entitlement to payments. The information will be used to process payment data from the Federal agency to the financial institution and/or its agent. 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.

INFORMATION FOUND ON CHECKS

Most of the information needed to complete boxes A, C, and F in Section 1 is printed on your government check:

ABe sure that payee’s name is written exactly as it appears on the check. Be sure current address is shown.

CClaim numbers and suffixes are printed here on checks beneath the date for the type of payment shown here. Check the Green Book for the location of prefixes and suffixes for other types of payments.

FType of payment is printed to the left of the amount.

				15-51
	Month Day Year			000			Check No.
	Month Day Year			PHILADELPHIA, PA			Check No.
	08	31	84	PHILADELPHIA, PA			0000 415785
	08	31	84				0000 415785
			00		C	28 28 DOLLARS CTS
	Pay to
	the order of					F
						F
		A				NOT NEGOTIABLE
		:00000518’:			0415771926”

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

Joint account holders 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.

CANCELLATION

The agreement represented by this authorization remains in effect until cancelled by the recipient by notice to the Federal agency or by the death or legal incapacity of the recipient. Upon cancellation by the recipient, the recipient should notify the receiving financial institution that he/she is doing so.

The agreement represented by this authorization may be cancelled by the financial institution by providing the recipient a written notice 30 days in advance of the cancellation date. The recipient must immediately advise the Federal agency if the authorization is cancelled by the financial institution. The financial institution cannot cancel the authorization by advice to the Government agency.

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.

How to Edit Standard Form 1199A Direct Deposit Online for Free

The PDF editor that you can go with was designed by our leading computer programmers. You may submit the usaa blank check file instantly and efficiently with our software. Merely keep up with the procedure to get going.

Step 1: Select the "Get Form Now" button to start out.

Step 2: You're now on the document editing page. You may edit, add content, highlight specific words or phrases, place crosses or checks, and insert images.

The PDF template you decide to fill out will contain the next segments:

part 1 to writing 1199a direct deposit form usaa

You should enter the particulars within the box GOVERNMENT AGENCY NAME, GOVERNMENT AGENCY ADDRESS, SECTION TO BE COMPLETED BY PAYEE, NAME AND ADDRESS OF FINANCIAL, ROUTING NUMBER, SECTION TO BE COMPLETED BY, CHECK DIGIT, DEPOSITOR ACCOUNT TITLE, FINANCIAL INSTITUTION CERTIFICATION, I confirm the identity of the, PRINT OR TYPE REPRESENTATIVES NAME, SIGNATURE OF REPRESENTATIVE, TELEPHONE NUMBER, DATE, and Financial institutions should.

Finishing 1199a direct deposit form usaa part 2

It's essential to point out the relevant details within the A separate form must be completed, SECTION TO BE COMPLETED BY PAYEE, NAME OF PAYEE last first middle, ADDRESS street route PO Box APOFPO, CITY, STATE, ZIP CODE, TELEPHONE NUMBER AREA CODE, NAME OF PERSONS ENTITLED TO PAYMENT, CLAIM OR PAYROLL ID NUMBER, Prefix, Suffix, TYPE OF DEPOSITOR ACCOUNT, CHECKING, and SAVINGS area.

step 3 to entering details in 1199a direct deposit form usaa

The NAME AND ADDRESS OF FINANCIAL, ROUTING NUMBER, SECTION TO BE COMPLETED BY, CHECK DIGIT, DEPOSITOR ACCOUNT TITLE, FINANCIAL INSTITUTION CERTIFICATION, I confirm the identity of the, PRINT OR TYPE REPRESENTATIVES NAME, SIGNATURE OF REPRESENTATIVE, TELEPHONE NUMBER, DATE, Financial institutions should, and FINANCIAL INSTITUTION COPY section is the place to include the rights and obligations of each side.

part 4 to filling out 1199a direct deposit form usaa

Complete the template by reviewing the following areas: A separate form must be completed, SECTION TO BE COMPLETED BY PAYEE, NAME OF PAYEE last first middle, ADDRESS street route PO Box APOFPO, CITY, STATE, ZIP CODE, TELEPHONE NUMBER AREA CODE, NAME OF PERSONS ENTITLED TO PAYMENT, CLAIM OR PAYROLL ID NUMBER, Prefix, Suffix, TYPE OF DEPOSITOR ACCOUNT, CHECKING, and SAVINGS.

Completing 1199a direct deposit form usaa step 5

Step 3: Click "Done". You can now export your PDF form.

Step 4: To protect yourself from all of the issues in the long run, you will need to make around several duplicates of your form.

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