Transcription of INSTRUCTIONS for 1199A Form - DOL
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INSTRUCTIONS for 1199A Form - DOL
INSTRUCTIONS for 1199A Form Section 1 (To be completed by Payee) A. Type or print your name, address and telephone number. B. Type or print your name. C. Type or print your 9-digit social security number. D. Check the type of account you want your funds deposited into. E. Type or print the account number you want your funds deposited into F. (Completed by Agency) G. Leave Blank Sign and date the form. Section 2 (Completed by Agency) Section 3 (To be completed by your financial institution) Standard Form 1199A (EG) OMB No. 1510-0007 (Rev. August 2012) Prescribed by Treasury Department DIRECT DEPOSIT SIGN-UP FORM Treasury Dept. Cir. 1076 DIRECTIONS To sign up for Direct Deposit, the payee is to read the back of this form The claim number and type of payment are printed on Government and fill in the information requested in Sections 1 and 2.
The financial institution will information is also stated on beneficiary/annuitant award letters and verify the information in Sections 1 and 2, and will complete Section 3. ... 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 ...
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