Treasury Direct Account Authorization Form PDF Details

The Treasury Direct Account Authorization, denoted as FS Form 5444 (Revised February 2021), plays a fundamental role in the activation and management of TreasuryDirect accounts. This document, regulated by the Office of Management and Budget (OMB No. 1530-0071), serves as a crucial step for individuals looking to utilize TreasuryDirect services, outlining a stringent process for account validation. Applicants are advised to accurately complete the form with ink or typewritten entries, ensuring all details are truthful, correct, and complete under the penalty of perjury, as mandated by the provisions of 31 CFR Part 363. Noteworthy is the necessity of signing the form in the presence of an authorized certifying officer—an official stationed at financial institutions across the United States, excluding notaries whose certification is deemed unacceptable. This selection criteria for certifying officers underscores the form’s emphasis on security and credibility in the activation process. The completed form must then be sent to Treasury Retail Securities Services, with specific instructions provided for both the applicant and the certifying officer regarding the signing and certification process. Additionally, the form includes a notice under the Privacy and Paperwork Reduction Acts, affirming the confidentiality of the information provided and its limited disclosure strictly regulated by law. This procedure not only facilitates the efficient processing and management of TreasuryDirect accounts but also safeguards the integrity of the financial transactions and information of the parties involved.

QuestionAnswer
Form NameTreasury Direct Account Authorization Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestreasurydirect fs form, treasury direct account form, form 5444 online, treasurydirect form account

Form Preview Example

 

 

FS Form 5444 (Revised February 2021)

OMB No. 1530-0071

TreasuryDirect® Account Authorization

IMPORTANT: Follow instructions in filling out this form. Making any false, fictitious, or fraudulent claim or statement to the United States is a crime and may be prosecuted. Print in ink or type all information.

INSTRUCTIONS

1.Sign in ink in the presence of a certifying officer. Identification may be required.

2.Authorized certifying officers are available at financial institutions, including credit unions, in the United States. Certification by a notary isn’t acceptable.

3.Mail the completed authorization form to: Treasury Retail Securities Services, PO Box 7015, Minneapolis, MN 55480-7015.

AUTHORIZATION

I submit this account authorization pursuant to the provisions of 31 CFR Part 363. I understand that my TreasuryDirect account will be activated upon receipt and approval of this authorization. Under penalty of perjury, I certify the information provided is true, correct and complete.

_______________________________________________________________

____________________________________

 

 

 

 

(TreasuryDirect Account Number)

_____________________________________________________

______________________________________________

 

(Print Name)

 

 

(Social Security Number - REQUIRED)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

 

 

(Daytime Telephone Number)

_____________________________________________________

______________________________________________

(City)

(State)

(ZIP Code)

 

(E-mail Address)

 

 

 

 

 

Check to remove Hardlock

Instructions to Certifying Officer: 1. Name(s) of the person(s) who appeared and date of appearance MUST be completed. 2. Original signature is required if a Medallion stamp is used. 3. Person(s) must sign in your presence.

I CERTIFY that ________________________________________________________________________ , whose identity(ies)

(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _______________ day of _______________

__________

 

(Month)

(Year)

at ___________________________________________________ and signed this form.

 

(City, State)

 

 

________________________________________________________

 

 

(Signature and Title of Certifying Officer)

 

 

________________________________________________________

 

 

(Name of Financial Institution)

 

 

________________________________________________________

 

 

(Address)

 

 

________________________________________________________

 

 

(City, State, ZIP code)

 

 

________________________________________________________

SEE PAGE 2 FOR TYPES OF ACCEPTABLE CERTIFICATIONS

(Telephone)

 

 

FS Form 5444

Department of the Treasury | Bureau of the Fiscal Service

1

Acceptable seals and stamps:

The financial institution’s official seal or stamp, including: Signature Guaranteed seal or stamp; Endorsement Guaranteed seal or stamp; Corporate seal or stamp (a corporate resolution isn’t required); or Issuing or paying agent seal or stamp (including name, location, and four-digit identification number or nine-digit routing number).

The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved Medallion Programs.

Sample certification for a financial institution:

 

Acceptable certification for a brokerage:

SIGNATURE GUARANTEED

 

SIGNATURE GUARANTEED

ABC National Bank

 

MEDALLION GUARANTEED

Hillview Branch

 

Generic Brokerage

 

 

 

Authorized Signature

 

Authorized Signature

 

 

XXXXXXXX

 

 

SECURITIES TRANSFER AGENTS MEDALLION PROGRAM

 

 

[Bar Code]

The following are NOT acceptable forms of certification for this document:

Notary Certification

Bank Address stamp

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS

The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. CH. 31 relating to the public debt of the United States. The furnishing of a Social Security Number, if requested, is also required by Section 6109 of the Internal Revenue Code (26 U.S.C. 6109).

The purpose of requesting the information is to enable the Bureau of the Fiscal Service and its agents to issue securities, process transactions, make payments, identify owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing the information is voluntary; however, without the information, the Fiscal Service may be unable to process transactions.

Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and the Privacy Act. This information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation purposes; others entitled to distribution or payment; agents and contractors to administer the public debt; agencies or entities for debt collection or to obtain current addresses for payment; agencies through approved computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; as otherwise authorized by law or regulation.

We estimate it will take you about 5 minutes to complete this form. However, you are not required to provide information requested unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Bureau of the Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed form to this

address; send to the correct address shown in the INSTRUCTIONS above.

FS Form 5444

Department of the Treasury | Bureau of the Fiscal Service

2

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