Sign-Up Form for
You may also sign up online today at
toll free at 1 (800) 333-1795
of Federal Benefit Payments
(for social security, railroad retirement board, civil (non-military)
retirement payments or VA
FMS Form 1200
OMB No. 1510-0007
You must complete boxes A, B, C, D, E and F.
Please read the information on page 2 before completing this form.
Only complete this form to sign up for direct deposit if you are an individual, or a representative payee of an individual, who receives checks
for the following types of federal benefits: social security, supplemental security income, railroad retirement, civil (non-military)
retirement, or VA (compensation or pension only). If you currently receive your payment by direct deposit you may not use
this form. Please refer to page 2 for further instructions.
FEDERAL BENEFIT RECIPIENT INFORMATION
BANK OR CREDIT UNION INFORMATION
(print name[s] and address exactly as they appear on your benefit check)
NAME OF PERSON ENTITLED TO GOVERNMENT BENEFITS (BENEFICIARY)
DEPOSITOR ACCOUNT TITLE (name[s] on account)
NAME OF REPRESENTATIVE PAYEE
** 9-DIGIT ROUTING NUMBER
if yes, enter
name at right
(see sample check below)
ADDRESS (street, route, P.O. box, apartment number)
2 6 3 1 8 2 7 9 4
** ACCOUNT NUMBER (see sample check below; do not include check number)
DAYTIME TELEPHONE NUMBER
** You may also attach a voided personal check. If you are depositing into a savings account, you
) ___________ - _______________
may need to contact your financial institution to obtain the routing and account numbers.
SOCIAL SECURITY NUMBER OF PERSON ENTITLED TO GOVERNMENT BENEFITS
SAMPLE CHECK (bottom left corner)
TYPE OF PAYMENT
(check only one) You must complete a separate form for each type of federal payment.
SUPPLEMENTAL SECURITY INCOME
VA (COMP/PENSION ONLY)
CIVIL (NON-MILITARY) RETIREMENT
For military, federal salary, veterans benefits or other federal payments
not available through Go Direct, please contact the paying agency
(see page 2 for a partial list of paying agencies).
In order to process your request,
enter the amount
number (found on documents from your paying
of your last benefit payment.
the check number from your last
CHECK NUMBER (YOUR MOST RECENT PAYMENT)
AMOUNT OF YOUR MOST RECENT PAYMENT
payment (found in the upper right-hand corner
of your Treasury check)
must be entered
I certify that I am entitled to receive the payment identified above, and that I have
FOR JOINT ACCOUNT HOLDERS
read and understand the back of this form. In signing this form, I authorize this
payment to be sent to the financial institution named in Part B above, to be
I certify that I have read the SPECIAL NOTICE TO JOINT ACCOUNT
deposited into the account above.
HOLDERS on the back of this form.
Be sure to complete all sections of this form.
This form is
to be used for switching from check payments to direct deposit of certain federal
Otherwise, the form cannot be processed.
benefits listed in Box C. Use of this form for any other purposes will result in the form being rejected.
Return the completed form to:
Contact your paying agency to:
Go Direct Processing Center
Update your name or address
U.S. Department of the Treasury
Change your account information if you already receive your payment by direct deposit, or
P.O Box 650527
Sign up for direct deposit for military, federal salary, veterans benefits, or other federal
payments not processed by
Dallas, TX 75265-0527