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. Then take or checks. (See the sample check on the back of this form .)

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

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