TN 98 (04-18)

A. When to accept the SF-1199A

We only accept the SF-1199A for specific situations mentioned in GN 02402.070B.

If you receive an SF-1199A in the FO for any reason other than listed in GN 02402.070, follow the instructions to release an “Elimination of Domestic Direct Deposit SF-1199A Notification” per GN 02402.025B.

Retain completed forms for 3 months before destroying.

In situations that require the SF-1199A, take the following steps:

• For initial claims, accept the SF-1199A to establish direct deposit. Receipt the direct deposit issue on the Development Worksheet (DW01), and then destroy the form.

• For postentitlement cases, retain completed forms for 3 months after processing and then destroy.

NOTE: Complete a separate form for each financial institution (FI) account and each type of benefit.

B. Description of SF-1199A entries

In this section, we describe the entries on form SF-1199A. Access the form at the following link https://www.gsa.gov/portal/forms/download/115702.

1. Section 1

a. Block A - Name of Payee

Print the name of the claimant (if capable) or representative payee (if the claimant is a minor child or not capable).

b. Block B - Name of Person Entitled to Payment

Print the name of the claimant included in the request.

c. Block C - Claim or Payroll ID Name

Print the claimant’s SSN and Beneficiary Identification Code (BIC) or Individual Recipient Identification (ID).

d. Block D - Type of Account

Check the appropriate box for checking or savings account.

e. Block E - Depositor Account Number (DAN)

Print the DAN per GN 02402.035.

f. Block F - Type of Payment

Indicate Social Security or Supplemental Security Income, as appropriate.

g. Block G - Allotment Information

Do not complete this block, since SSA only approves direct deposit for the full payment amount.

h. Signature Block - Payee/Joint Payee Certification

This block must contain the claimant or representative payee’s signatures.

i. Optional Signature Block - Joint Account Holder's Certification

This block is usually not completed. If it shows a signature of a person not shown in the depositor account title, check the accuracy of the account title.

2. Section 2

A complete SF-1199A is required for Social Security or Supplemental Security Income benefits.

3. Section 3

a. Name and Address of Financial Institution

Print the name and address of the FI.

b. Routing Number (RTN)

Print the RTN and appropriate check digit per GN 02402.035.

c. Depositor Account Title

Print the exact title of the account per GN 02402.050.

d. Financial Institution Certification

A representative of the FI should complete and sign this block.