Fillable Direct Deposit Sign Up Form - Gte Financial (Page 2 of 2) in pdf

PLEASE READ THIS CAREFULLY

PRIVACY ACT NOTICE

Your social security number and the other information requested will allow the federal government to make payments to you by

direct deposit. This collection of information is authorized by Title 31 of the United States Code, Section 3332(g). Also, Executive

Order 9397, November 22, 1943, authorizes the use of your social security number. Your social security number is requested to

ensure the accurate identification and retention of records pertaining to you and to distinguish you from other recipients of federal

payments.

This information will be disclosed to the Department of the Treasury or another disbursing official to process federal payments to

you by direct deposit. This information may also be disclosed to a court, congressional committee or another government agency as

authorized or required by federal law and to your financial institution to verify receipt of your federal payments. Although providing

the requested information is voluntary, your direct deposit payment may be delayed or Treasury may be unable to send it if you fail

to provide the information.

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

If your account is a joint account and receives direct deposit benefit payments, you must inform the federal agency and the financial

institution of the death of a beneficiary. Payments sent by direct deposit after the date of death or ineligibility of a beneficiary (except

for salary payments) must be returned to the federal agency. The federal agency will then determine if the survivor is eligible for

benefits.

CANCELLATION

Your payment will be sent by direct deposit until the federal agency that issues the payments is notified to cancel, such as in the case of

death or legal incapacity of the person receiving the payment.

Your financial institution may cancel your direct deposit authorization. Your financial institution is required to give you written notice

30 days in advance of the cancellation date. If this occurs, you must notify the federal agency that the direct deposit authorization

was cancelled.

Please contact your paying agency to:

Update your name or address

Change your account information if you already receive your payment by direct deposit, or

payments not processed by

Go Direct

Department of Veterans Affairs

Railroad Retirement Board

(877) 838-2778

(Automated System)

(800) 808-0772

(800) 827-1000

(800) 829-4833 TDD

(312) 751-4701 TTY

Office of Personnel Management

Social Security Administration

(800) 772-1213

(888) 767-6738

(800) 325-0778 TTY

(800) 878-5707 TDD

BURDEN ESTIMATE STATEMENT

The estimated average time (burden hours) associated with filling out this paperwork is 10 minutes per respondent or recordkeeper,

depending on individual circumstances. Comments concerning the accuracy of this time estimate and suggestions for reducing the

burden should be directed to the Financial Management Service, Administrative Programs Division, Records and Information

Management Program, 3700 East-West Highway, Room 135, Hyattsville, MD 20782. THIS ADDRESS SHOULD ONLY BE USED

FOR COMMENTS AND/OR SUGGESTIONS CONCERNING THE AMOUNT OF TIME SPENT COLLECTING THE DATA. DO NOT

SEND THE COMPLETED PAPERWORK TO THE ADDRESS ABOVE FOR PROCESSING.

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Direct Deposit Sign Up Form - Gte Financial Page 2

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