Form SF 1199A, Direct Deposit Sign-Up Instructions

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This form contains 206 fields organized into 24 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Account Details
active Text
Enter the details for an active account.
retire Text
Enter the details for a retirement account.
surv Text
Enter the details for a survivor benefit account.
other Text
Enter the details for another type of benefit account.
Account Information
acctitle Text
Enter the title of the account, such as 'Checking' or 'Savings'.
acctitle Text
Enter the title of the account where the direct deposit will be made.
acctitle Text
Enter the title of the account holder as it appears on the account. This is typically the name associated with the bank account.
Account Number
Depositor Account Number Text
Enter the full account number for the depositor’s bank account to be used for direct deposit (include any leading zeros or dashes exactly as shown by your bank).
Max length: 51 characters
Account Status
xact CheckBox
Check this box if the payment is for an active account.
xret CheckBox
Check this box if the payment is for a retirement account.
Account Type
xcheck CheckBox
Check this box if the account type is a checking account.
xsvgs CheckBox
Check this box if the account type is a savings account.
xcheck CheckBox
Check this box if the account is a checking account.
xsvgs CheckBox
Check this box if the account is a savings account.
xcheck CheckBox
Check this box if the account type is checking.
xsvgs CheckBox
Check this box if the account type is savings.
Additional Information
active Text
Enter any additional information related to active duty status.
retire Text
Enter any additional information related to retirement status.
surv Text
Enter any additional information related to survivor status.
other Text
Enter any other relevant information not covered by the other fields.
Agency Information
agcyname Text
Enter the name of the government agency authorizing the payment.
agcyaddr Text
Enter the address of the government agency authorizing the payment.
agcyname Text
Enter the name of the government agency making the payment.
agcyname Text
Enter the name of the government agency making the payment.
agcyaddr Text
Enter the address of the government agency making the payment.
Authorization
payeesign1 Text
Enter the signature of the payee authorizing the direct deposit.
payeedate1 Date
Enter the date when the payee signed the authorization.
jointsign1 Text
Enter the signature of the joint account holder, if applicable.
jointdate1 Date
Enter the date when the joint account holder signed the authorization.
payeesign2 Text
Enter the signature of the payee authorizing the direct deposit, if a second signature is required.
payeesign1 Text
Enter the payee's signature for authorization.
payeedate1 Date
Enter the date when the payee signed the form.
jointsign1 Text
Enter the joint account holder's signature for authorization.
jointdate1 Date
Enter the date when the joint account holder signed the form.
payeesign2 Text
Enter the second payee's signature for authorization, if applicable.
payeedate2 Date
Enter the date when the second payee signed the form, if applicable.
jointsign2 Text
Enter the second joint account holder's signature for authorization, if applicable.
jointdate2 Date
Enter the date when the second joint account holder signed the form, if applicable.
payeesign1 Text
Enter the signature of the payee for authorization.
payeedate1 Date
Enter the date when the payee signed the form.
jointsign1 Text
Enter the signature of the joint account holder for authorization.
jointdate1 Date
Enter the date when the joint account holder signed the form.
payeesign2 Text
Enter the second signature of the payee if required.
payeedate2 Date
Enter the date of the second signature of the payee.
jointsign2 Text
Enter the second signature of the joint account holder if required.
jointdate2 Date
Enter the date of the second signature of the joint account holder.
Bank Information
Routing Number Text
Enter the bank's routing (ABA) transit number used for this account for electronic funds transfer.
Max length: 24 characters
Check Digit (left box) Text
Enter the single numeric character for the bank routing/check digit in the left check-digit box.
Max length: 3 characters
Benefit Amount
active Number
Enter the amount of Active Duty benefits you are receiving.
retire Number
Enter the amount of Retirement benefits you are receiving.
surv Number
Enter the amount of Survivor benefits you are receiving.
other Number
Enter the amount of other benefits you are receiving.
Benefit Type
xrr CheckBox
Check this box if you are receiving Railroad Retirement benefits.
xcsr CheckBox
Check this box if you are receiving Civil Service Retirement benefits.
xva CheckBox
Check this box if you are receiving Veterans Affairs benefits.
xfed CheckBox
Check this box if you are receiving Federal benefits.
xact CheckBox
Check this box if you are receiving Active Duty benefits.
xret CheckBox
Check this box if you are receiving Retirement benefits.
xsurv CheckBox
Check this box if you are receiving Survivor benefits.
xother CheckBox
Check this box if you are receiving other types of benefits not listed.
xsurv CheckBox
Check this box if the payment is for a survivor benefit.
xother CheckBox
Check this box if the payment is for another type of benefit not listed.
Entitlement Information
entname Text
Enter the name of the entity entitled to receive the payment.
entname Text
Enter the name of the entity entitled to the payment.
entname Text
Enter the name of the entity entitled to the payment.
Financial Institution Information
inst Text
Enter the name of the financial institution where the account is held.
inst Text
Enter the name of the financial institution where the direct deposit will be made.
inst Text
Enter the name of the financial institution where the account is held.
Form Actions
Reset Button
Click this button to reset the form to its default state.
Reset Button
Click this button to reset the form fields to their default values.
Reset Button
Press this button to reset the form fields to their default values.
General
acct1 Number
Max length: 1 characters
acct2 Number
Max length: 1 characters
acct3 Number
Max length: 1 characters
acct4 Number
Max length: 1 characters
acct5 Number
Max length: 1 characters
acct6 Number
Max length: 1 characters
acct7 Number
Max length: 1 characters
acct8 Number
Max length: 1 characters
acct9 Number
Max length: 1 characters
acct10 Number
Max length: 1 characters
acct11 Number
Max length: 1 characters
acct12 Number
Max length: 1 characters
acct13 Number
Max length: 1 characters
acct14 Number
Max length: 1 characters
acct15 Number
Max length: 1 characters
acct16 Number
Max length: 1 characters
acct1 Number
Max length: 1 characters
acct2 Number
Max length: 1 characters
acct3 Number
Max length: 1 characters
acct4 Number
Max length: 1 characters
acct5 Number
Max length: 1 characters
acct6 Number
Max length: 1 characters
acct7 Number
Max length: 1 characters
acct8 Number
Max length: 1 characters
acct9 Number
Max length: 1 characters
acct10 Number
Max length: 1 characters
acct11 Number
Max length: 1 characters
acct12 Number
Max length: 1 characters
acct13 Number
Max length: 1 characters
acct14 Number
Max length: 1 characters
acct15 Number
Max length: 1 characters
acct16 Number
Max length: 1 characters
acct17 Number
Max length: 1 characters
rout1 Number
Max length: 1 characters
rout2 Number
Max length: 1 characters
rout3 Number
Max length: 1 characters
rout4 Number
Max length: 1 characters
rout5 Number
Max length: 1 characters
rout6 Number
Max length: 1 characters
rout7 Number
Max length: 1 characters
rout8 Number
Max length: 1 characters
ckdigit Number
Max length: 1 characters
acct1 Number
Max length: 1 characters
acct2 Number
Max length: 1 characters
acct3 Number
Max length: 1 characters
acct4 Number
Max length: 1 characters
acct5 Number
Max length: 1 characters
acct6 Number
Max length: 1 characters
acct7 Number
Max length: 1 characters
acct8 Number
Max length: 1 characters
acct9 Number
Max length: 1 characters
acct10 Number
Max length: 1 characters
acct11 Number
Max length: 1 characters
acct12 Number
Max length: 1 characters
acct13 Number
Max length: 1 characters
acct14 Number
Max length: 1 characters
acct15 Number
Max length: 1 characters
acct16 Number
Max length: 1 characters
acct17 Number
Max length: 1 characters
xfed CheckBox
Check this box if the payment is from a federal agency.
rout2 Number
Max length: 1 characters
rout1 Number
Max length: 1 characters
rout3 Number
Max length: 1 characters
rout4 Number
Max length: 1 characters
rout5 Number
Max length: 1 characters
rout6 Number
Max length: 1 characters
rout7 Number
Max length: 1 characters
rout8 Number
Max length: 1 characters
ckdigit Number
Max length: 1 characters
Government Agency Information
agcyaddr Text
Enter the address of the government agency responsible for the payment.
Joint Account Information
jointsign2 Text
Enter the signature of the joint account holder, if applicable.
jointdate2 Date
Enter the date when the joint account holder signed the form.
Payee Information
payphone Text
Enter the phone number associated with the payee's account.
prefix Text
Enter the prefix of the payee's name, such as Mr., Mrs., or Dr.
idno Text
Enter the identification number associated with the payee.
suffix Text
Enter the suffix of the payee's name, such as Jr., Sr., or III.
payeedate2 Date
Enter the date when the payee signed the form.
payname Text
Enter the full name of the payee.
paystreet Text
Enter the street address of the payee.
paycity Text
Enter the city of the payee's address.
paystate Text
Enter the state of the payee's address.
payzip Text
Enter the ZIP code of the payee's address.
payphone Text
Enter the phone number of the payee.
payname Text
Enter the name of the payee receiving the direct deposit.
paystreet Text
Enter the street address of the payee.
paycity Text
Enter the city of the payee's address.
paystate Text
Enter the state of the payee's address.
payzip Text
Enter the ZIP code of the payee's address.
payphone Text
Enter the payee's phone number.
Payment Authorization
xss CheckBox
Check this box if you are authorizing the direct deposit of Social Security payments.
xssi CheckBox
Check this box if you are authorizing the direct deposit of Supplemental Security Income payments.
Payment Details
paytype Text
Enter the type of payment being received.
payamt Number
Enter the amount of the payment being received.
Payment Information
paytype Text
Enter the type of payment being authorized for direct deposit.
payamt Number
Enter the amount of payment being authorized for direct deposit.
paytype Text
Enter the type of payment you are authorizing for direct deposit.
payamt Number
Enter the amount of payment you are authorizing for direct deposit.
Payment Type
xss CheckBox
Check this box if the payment is related to Social Security benefits.
xssi CheckBox
Check this box if the payment is related to Supplemental Security Income.
xrr CheckBox
Check this box if the payment is related to Railroad Retirement benefits.
xcsr CheckBox
Check this box if the payment is related to Civil Service Retirement benefits.
xva CheckBox
Check this box if the payment is related to Veterans Affairs benefits.
xfed CheckBox
Check this box if the payment is related to Federal benefits.
xact CheckBox
Check this box if the payment is related to Active Duty Military pay.
xret CheckBox
Check this box if the payment is related to Retirement benefits.
xsurv CheckBox
Check this box if the payment is related to Survivor benefits.
xother CheckBox
Check this box if the payment is related to any other type of benefit not listed.
xss CheckBox
Check this box if the payment is for Social Security benefits.
xssi CheckBox
Check this box if the payment is for Supplemental Security Income.
xrr CheckBox
Check this box if the payment is for Railroad Retirement benefits.
xcsr CheckBox
Check this box if the payment is for Civil Service Retirement benefits.
xva CheckBox
Check this box if the payment is for Veterans Affairs benefits.
Personal Information
payname Text
Enter the full name of the payee who is authorizing the direct deposit.
paystreet Text
Enter the street address of the payee.
paystate Text
Enter the state of residence of the payee.
paycity Text
Enter the city of residence of the payee.
payzip Text
Enter the ZIP code of the payee's address.
prefix Text
Enter your name prefix (e.g., Mr., Mrs., Dr.).
idno Text
Enter your identification number.
suffix Text
Enter your name suffix (e.g., Jr., Sr., III).
prefix Text
Enter the prefix for the payee's name, such as Mr., Mrs., or Dr.
idno Text
Enter the identification number associated with the payee.
suffix Text
Enter the suffix for the payee's name, such as Jr., Sr., or III.
Representative Information
repname Text
Enter the name of the representative completing the form on behalf of the payee.
repsign Text
Enter the signature of the representative completing the form on behalf of the payee.
repphone Text
Enter the phone number of the representative completing the form on behalf of the payee.
repdate Date
Enter the date when the representative signed the form.
repname Text
Enter the name of the representative verifying the information.
repsign Text
Enter the signature of the representative verifying the information.
repphone Text
Enter the phone number of the representative verifying the information.
repdate Date
Enter the date when the representative verified the information.
repname Text
Enter the name of the representative who is authorized to sign on behalf of the account holder.
repsign Text
Enter the signature of the representative who is authorized to sign on behalf of the account holder.
repphone Text
Enter the phone number of the representative who is authorized to sign on behalf of the account holder.
repdate Date
Enter the date when the representative signed the form.