Form SF 1199A, Direct Deposit Sign-Up Instructions

Enter the exact name or title of the bank account as it appears on the financial institution's records for the depositor (e.g., individual or joint account name).

Check this box if the depositor account being provided is a checking account where direct deposit funds should be sent.

Check this box if the depositor account being provided is a savings account where direct deposit funds should be sent.

If your payment is Federal salary or military civilian pay, enter the payment claim/type exactly as shown on your government check or award letter (or write 'Fed Salary/Mil Civilian Pay'); leave blank if not applicable.

If your payment is for active duty military pay, enter the payment claim/type exactly as shown on your government check or award letter (or write 'Military Active'); leave blank if not applicable.

If your payment is a military retirement payment, enter the payment claim/type exactly as shown on your government check or award letter (or write 'Military Retire'); leave blank if not applicable.

If your payment type is not listed, enter the specific payment type or claim name exactly as printed on your government check, award letter, or agency document.

Enter the full legal name of the government agency that is making the payment or administering the benefit.

Enter the complete mailing address of the government agency, including street address, city, state, and ZIP code.

Enter the type of payment you are authorizing for direct deposit.

Enter the amount of payment you are authorizing for direct deposit.

Enter a short description of the allotment's nature or designation (for example, 'fixed amount', 'percentage', or the recipient/purpose of the allotment).

Enter the dollar amount to be allotted from each payment.

Enter the payee's signature (the printed or handwritten name) certifying entitlement to the payment and authorizing the direct deposit.

Enter the date when the payee signed the certification.

Enter the signature of the joint account holder certifying they have read and understood the form and special notice.

Enter the date when the joint account holder signed the certification.

Enter an additional signature (for a second payee or joint account holder) authorizing the payment if applicable.

Enter your name prefix (e.g., Mr., Mrs., Dr.).

Enter your identification number.

Enter your name suffix (e.g., Jr., Sr., III).

Enter the prefix portion (if any) of your claim or payroll identification number exactly as shown on your government check or award documents.

Enter the main claim or payroll identification number (the primary identifier printed on your government check, award letter, or agency notice).

Enter the suffix portion (if any) of your claim or payroll identification number exactly as shown on your government check or award documents.

Enter the full bank account number for receiving direct deposit exactly as it appears on your bank statement or check, including any leading zeros and without spaces or hyphens. Fill only if 'CHECKING', 'SAVINGS' is 'Yes' (any).

Enter the full name(s) of the person(s) entitled to receive the payment (last name, first name, middle initial as applicable).

Enter the financial institution's routing number used to identify the bank for automated deposits.

Enter the check digit associated with the routing number (the verification digit that follows the routing number).

Enter the name of the financial institution where the direct deposit will be made.

Enter the title of the account where the direct deposit will be made.

Enter the full name and mailing address of the financial institution where the account is held, including street, city, state, and ZIP code.

Enter the account title or name on the depositor's account exactly as it appears at the financial institution (for example, the primary or joint account name).

Enter the name of the representative verifying the information.

Enter the signature of the representative verifying the information.

Enter the phone number of the representative verifying the information.

Enter the date when the representative verified the information.

Enter the full printed or typed name of the financial institution representative certifying this form.

Provide the handwritten signature of the financial institution representative certifying the accuracy of the information.

Enter a daytime telephone number, including area code, where the financial institution representative can be reached about this certification.

Enter the date the representative signed this certification.

Enter the full name of the financial institution and its complete mailing address (street, city, state, ZIP) as it appears on bank records.

Click this button to reset the form to its default state.

Click this button to reset the form fields to their default values.

Press this button to reset the form fields to their default values.

Enter the name of the government agency making the payment.

Enter the address of the government agency responsible for the payment.

Enter the full official name of the government agency or office responsible for the payment or benefit.

Enter the agency's complete mailing address, including street or P.O. Box, city, state, and ZIP code.

Enter the handwritten signature (or printed name if signing electronically) of the joint account holder certifying they have read and understood the form.

Enter the date when the joint account holder signed the certification.

Enter the name of the entity entitled to the payment.

Enter the full name(s) of the person or persons entitled to receive the payment (last name, first name, middle initial); if more than one person, separate names with commas.

Enter the payee's signature for authorization.

Enter the date when the payee signed the form.

Enter the joint account holder's signature for authorization.

Enter the date when the joint account holder signed the form.

Enter the second payee's signature for authorization, if applicable.

Enter the date when the second payee signed the form, if applicable.

Enter the second joint account holder's signature for authorization, if applicable.

Enter the date when the second joint account holder signed the form, if applicable.

Enter the primary payee or joint payee's signature authorizing the payment to be deposited.

Enter the date the primary payee signed the form.

Enter the signature of the primary joint account holder certifying they have read and understood the form.

Enter the date the primary joint account holder signed the form.

Enter the signature of a second payee or additional entitled person, if applicable.

Enter the date the additional payee signed the form.

Enter the signature of a second joint account holder, if applicable.

Enter the date the additional joint account holder signed the form.

Enter the three-digit area code for the payee's telephone number (the area code portion only).

Enter the prefix portion (if any) of the claim or payroll identification number as printed on your government check or award documents.

Enter the main numeric portion of the claim or payroll identification number as printed on your government check or award documents.

Enter the suffix portion (if any) of the claim or payroll identification number as printed on your government check or award documents.

Enter the date the payee or joint payee signed the certification.

Enter the full name of the payee.

Enter the street address of the payee.

Enter the city of the payee's address.

Enter the state of the payee's address.

Enter the ZIP code of the payee's address.

Enter the phone number of the payee.

Enter the payee's full name in the order last name, first name, and middle initial.

Enter the payee's mailing address (street, route, P.O. Box, or APO/FPO).

Enter the city for the payee's mailing address.

Enter the state for the payee's mailing address (state abbreviation or full state name).

Enter the ZIP code for the payee's mailing address (5- or 9-digit ZIP as applicable).

Enter the payee's telephone number including the area code.

Enter the type or purpose of the allotment for this payment (e.g., savings, child support, loan repayment, or the name of the payee receiving the allotment).

Enter the dollar amount of the allotment to be deducted from each payment and sent to the designated recipient.

Check this box if your direct deposit is for Social Security benefits.

Check this box if your direct deposit is for Supplemental Security Income (SSI) benefits.

Check this box if your direct deposit is for Railroad Retirement benefits.

Check this box if the payment to be deposited is a Civil Service retirement benefit administered by OPM.

Check this box if the deposit is for VA compensation or a VA pension.

Check this box if the deposit is for a Federal salary or military civilian pay.

Check this box if the deposit is for active-duty military pay.

Check this box if the deposit is for military retirement pay.

Check this box if the deposit is for military survivor benefits.

Check this box if your payment type is not listed and specify the payment type in the space provided.

Enter the payee's full name (last name, first name, and middle initial) as shown on government records.

Enter the payee's mailing address (street address, route, P.O. Box, or APO/FPO) where correspondence should be sent.

Enter the state or territory for the payee's mailing address.

Enter the city for the payee's mailing address.

Enter the ZIP code (or ZIP+4) for the payee's mailing address.

Enter the printed or typed full name of the financial institution representative completing this certification.

Enter the signature of the financial institution representative who is certifying the account information on this form.

Enter a daytime telephone number for the representative, including area code and extension if applicable.

Enter the date the representative signed this certification.

Check this box if the account is a checking account.

Check this box if the account is a savings account.

Check this box if the depositor account is a checking account (select only one account type).

Check this box if the depositor account is a savings account (select only one account type).

Check this box if you are authorizing the direct deposit of Social Security payments.

Check this box if you are authorizing the direct deposit of Supplemental Security Income payments.

Check this box if you are receiving Railroad Retirement benefits.

Check this box if you are receiving Civil Service Retirement benefits.

Check this box if you are receiving Veterans Affairs benefits.

Check this box if you are receiving Federal benefits.

Check this box if you are receiving Active Duty benefits.

Check this box if you are receiving Retirement benefits.

Check this box if you are receiving Survivor benefits.

Check this box if you are receiving other types of benefits not listed.

Enter the amount of Active Duty benefits you are receiving.

Enter the amount of Retirement benefits you are receiving.

Enter the amount of Survivor benefits you are receiving.

Enter the amount of other benefits you are receiving.

Check this box if the payment you are enrolling for direct deposit is Social Security benefits.

Check this box if the payment is Supplemental Security Income (SSI).

Check this box if the payment is Railroad Retirement benefits.

Check this box if the payment is Civil Service Retirement paid through OPM.

Check this box if the payment is VA compensation or a VA pension.

Check this box if the payment is a federal salary or military civilian pay.

Check this box if the payment is active military pay.

Check this box if the payment is military retired pay.

Check this box if the payment is a military survivor benefit.

Check this box if the payment type is not listed and write the specific type in the adjacent 'specify' space.

Enter the text or code to indicate this payment is for active duty military pay (Mil. Active).

Enter the text or code to indicate this payment is for military retired pay (Mil. Retire.).

Enter the text or code to indicate this payment is for a military survivor benefit (Mil. Survivor).

If the payment type is not listed, enter the specific payment type or brief description here. Fill only if 'Other (specify)' is 'Yes'.