Form 1199a Postal Direct Deposit
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1Postal Direct Deposit (form 1199-A)
Postal Direct Deposit (form 1199-A)
Postal Direct Deposit (form 1199-A)
Postal Direct Deposit (form 1199-A)
PRIVACY ACT:
PRIVACY ACT:
PRIVACY ACT:
PRIVACY ACT:
The collection of this information is authorized by 38 U.S.C. 401, 1003 and 5 U.S.C. 8339. This information will be used to transfer
The collection of this information is authorized by 38 U.S.C. 401, 1003 and 5 U.S.C. 8339. This information will be used to transfer
The collection of this information is authorized by 38 U.S.C. 401, 1003 and 5 U.S.C. 8339. This information will be used to transfer
The collection of this information is authorized by 38 U.S.C. 401, 1003 and 5 U.S.C. 8339. This information will be used to transfer
your salary of portion thereof, to financial organizations for credit to your designated account. As a routine use, this information may be disclosed to those
your salary of portion thereof, to financial organizations for credit to your designated account. As a routine use, this information may be disclosed to those
your salary of portion thereof, to financial organizations for credit to your designated account. As a routine use, this information may be disclosed to those
your salary of portion thereof, to financial organizations for credit to your designated account. As a routine use, this information may be disclosed to those
financial organizations, to an appropriate law enforcement agency for investigative or prosecutive purposes, to a congressional office at your request,
financial organizations, to an appropriate law enforcement agency for investigative or prosecutive purposes, to a congressional office at your request,
financial organizations, to an appropriate law enforcement agency for investigative or prosecutive purposes, to a congressional office at your request,
financial organizations, to an appropriate law enforcement agency for investigative or prosecutive purposes, to a congressional office at your request,
to DMB for review or private relief legislation and, where pertinent, in a legal proceeding to which the Postal Service is a party. Completion of this form is
to DMB for review or private relief legislation and, where pertinent, in a legal proceeding to which the Postal Service is a party. Completion of this form is
to DMB for review or private relief legislation and, where pertinent, in a legal proceeding to which the Postal Service is a party. Completion of this form is
to DMB for review or private relief legislation and, where pertinent, in a legal proceeding to which the Postal Service is a party. Completion of this form is
voluntary; however, if you fail to provide this information, your requested action will not be accomplished.
voluntary; however, if you fail to provide this information, your requested action will not be accomplished.
voluntary; however, if you fail to provide this information, your requested action will not be accomplished.
voluntary; however, if you fail to provide this information, your requested action will not be accomplished.
Part I (Initiated by Employee)
Part I (Initiated by Employee)
Part I (Initiated by Employee)
Part I (Initiated by Employee)
1. Employee Name (as shown on Check)
1. Employee Name (as shown on Check)
1. Employee Name (as shown on Check)
1. Employee Name (as shown on Check)
2. Social Security Number
2. Social Security Number
2. Social Security Number
2. Social Security Number
3. Home Address (No. and Street, Apt., City, State, ZIP +4)
3. Home Address (No. and Street, Apt., City, State, ZIP +4)
3. Home Address (No. and Street, Apt., City, State, ZIP +4)
3. Home Address (No. and Street, Apt., City, State, ZIP +4)
4a. Postal Installation where Employed (City, State, ZIP + 4)
4a. Postal Installation where Employed (City, State, ZIP + 4)
4a. Postal Installation where Employed (City, State, ZIP + 4)
4a. Postal Installation where Employed (City, State, ZIP + 4)
4b. Finance Number
4b. Finance Number
4b. Finance Number
4b. Finance Number
Complete Only ONE Item Below
Complete Only ONE Item Below
Complete Only ONE Item Below
Complete Only ONE Item Below
5a. ESTABLISH a NET CHECK to a Financial Institution
5a. ESTABLISH a NET CHECK to a Financial Institution
5a. ESTABLISH a NET CHECK to a Financial Institution
5a. ESTABLISH a NET CHECK to a Financial Institution
5b. CANCEL a NET CHECK to a Financial Institution
5b. CANCEL a NET CHECK to a Financial Institution
5b. CANCEL a NET CHECK to a Financial Institution
5b. CANCEL a NET CHECK to a Financial Institution
5c. ESTABLISH an ALLOTMENT in the Amount of:
5c. ESTABLISH an ALLOTMENT in the Amount of:
5c. ESTABLISH an ALLOTMENT in the Amount of:
5c. ESTABLISH an ALLOTMENT in the Amount of:
5d. CHANGE My PRESENT ALLOTMENT
5d. CHANGE My PRESENT ALLOTMENT
5d. CHANGE My PRESENT ALLOTMENT
5d. CHANGE My PRESENT ALLOTMENT
$
$
$
$
.00
.00
.00
.00
From $
From $
From $
From $
.00 To $
.00 To $
.00 To $
.00 To $
.00
.00
.00
.00
5e. CANCEL my ALLOTMENT in the Amount of:
5e. CANCEL my ALLOTMENT in the Amount of:
5e. CANCEL my ALLOTMENT in the Amount of:
5e. CANCEL my ALLOTMENT in the Amount of:
5f. Check ( ) This Item if you Have More Than one Allotment to a
5f. Check ( ) This Item if you Have More Than one Allotment to a
5f. Check ( ) This Item if you Have More Than one Allotment to a
5f. Check ( ) This Item if you Have More Than one Allotment to a
Financial Organization
Financial Organization
Financial Organization
Financial Organization
$
$
$
$
.00
.00
.00
.00
I certify that I am entitled to the payment identified above, and that I have read and understand the information printed above. In signing this form, I
I certify that I am entitled to the payment identified above, and that I have read and understand the information printed above. In signing this form, I
I certify that I am entitled to the payment identified above, and that I have read and understand the information printed above. In signing this form, I
I certify that I am entitled to the payment identified above, and that I have read and understand the information printed above. In signing this form, I
authorize my payment to be sent to the Financial Institution named below to deposited to the designated account.
authorize my payment to be sent to the Financial Institution named below to deposited to the designated account.
authorize my payment to be sent to the Financial Institution named below to deposited to the designated account.
authorize my payment to be sent to the Financial Institution named below to deposited to the designated account.
1
1
1
1
6a. Employee (Signature)
6a. Employee (Signature)
6a. Employee (Signature)
6a. Employee (Signature)
6b. Date Signed
6b. Date Signed
6b. Date Signed
6b. Date Signed
6c. Effective Date
6c. Effective Date
6c. Effective Date
6c. Effective Date
)
)
)
)
Part II - (Completed by Financial Organization, Return Original and Copy to Employee
Part II - (Completed by Financial Organization, Return Original and Copy to Employee
Part II - (Completed by Financial Organization, Return Original and Copy to Employee
Part II - (Completed by Financial Organization, Return Original and Copy to Employee
Financial Institution Certification
Financial Institution Certification
Financial Institution Certification
Financial Institution Certification
I confirm the identity of the above named payee(s) and the account number and title. As representative of the below named financial institution, I certify
I confirm the identity of the above named payee(s) and the account number and title. As representative of the below named financial institution, I certify
I confirm the identity of the above named payee(s) and the account number and title. As representative of the below named financial institution, I certify
I confirm the identity of the above named payee(s) and the account number and title. As representative of the below named financial institution, I certify
that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210. Pursuant
that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210. Pursuant
that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210. Pursuant
that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210. Pursuant
to Treasury Department regulations, multiple deposits will not be made to a common account.
to Treasury Department regulations, multiple deposits will not be made to a common account.
to Treasury Department regulations, multiple deposits will not be made to a common account.
to Treasury Department regulations, multiple deposits will not be made to a common account.
2
2
2
2
Check Digit
Check Digit
Check Digit
Check Digit
7b. Financial Organization Routing Number
7b. Financial Organization Routing Number
7b. Financial Organization Routing Number
7b. Financial Organization Routing Number
7a. Financial Organization (Name, No, and Street, City, State, ZIP +4)
7a. Financial Organization (Name, No, and Street, City, State, ZIP +4)
7a. Financial Organization (Name, No, and Street, City, State, ZIP +4)
7a. Financial Organization (Name, No, and Street, City, State, ZIP +4)
N A PFE FED E RA L CR E D IT UN IO N
N A PFE FED E RA L CR E D IT UN IO N
N A PFE FED E RA L CR E D IT UN IO N
N A PFE FED E RA L CR E D IT UN IO N
2
2
2
2
5
5
5
5
4
4
4
4
0
0
0
0
7
7
7
7
9
9
9
9
8
8
8
8
7
7
7
7
4
4
4
4
1 6 2 8 11 TH S T RE E T, N. W.
1 6 2 8 11 TH S T RE E T, N. W.
1 6 2 8 11 TH S T RE E T, N. W.
1 6 2 8 11 TH S T RE E T, N. W.
7c. Employee s Account Number To Be Credited (Up to 17 positions)
7c. Employee s Account Number To Be Credited (Up to 17 positions)
7c. Employee s Account Number To Be Credited (Up to 17 positions)
7c. Employee s Account Number To Be Credited (Up to 17 positions)
WA SH I N G TON , D . C . 2 00 01 -5 011
WA SH I N G TON , D . C . 2 00 01 -5 011
WA SH I N G TON , D . C . 2 00 01 -5 011
WA SH I N G TON , D . C . 2 00 01 -5 011
7d. Type of Account
7d. Type of Account
7d. Type of Account
7d. Type of Account
Savings
Savings
Savings
Savings
Checking
Checking
Checking
Checking
Authorized By
Authorized By
Authorized By
Authorized By
8a. Name (Print or Type)
8a. Name (Print or Type)
8a. Name (Print or Type)
8a. Name (Print or Type)
8b. Title
8b. Title
8b. Title
8b. Title
8c. Signature
8c. Signature
8c. Signature
8c. Signature
8d. Date Signed
8d. Date Signed
8d. Date Signed
8d. Date Signed
1
1
1
1
Request must be received as Postal Data Center or DDE site no later than Wednesday of the week in which the pay period ends in order to be
Request must be received as Postal Data Center or DDE site no later than Wednesday of the week in which the pay period ends in order to be
Request must be received as Postal Data Center or DDE site no later than Wednesday of the week in which the pay period ends in order to be
Request must be received as Postal Data Center or DDE site no later than Wednesday of the week in which the pay period ends in order to be
effective for a particular pay period. Later receipts will be processed the following pay period.
effective for a particular pay period. Later receipts will be processed the following pay period.
effective for a particular pay period. Later receipts will be processed the following pay period.
effective for a particular pay period. Later receipts will be processed the following pay period.
2
2
2
2
Financial organizations must furnish their routing transit number (the number assigned by Rand McNally) This is an eight digit number PLUS
Financial organizations must furnish their routing transit number (the number assigned by Rand McNally) This is an eight digit number PLUS
Financial organizations must furnish their routing transit number (the number assigned by Rand McNally) This is an eight digit number PLUS
Financial organizations must furnish their routing transit number (the number assigned by Rand McNally) This is an eight digit number PLUS
a single number check digit. It is IMPORTANT that this be accurate, as disbursements will be made according to this routing number.
a single number check digit. It is IMPORTANT that this be accurate, as disbursements will be made according to this routing number.
a single number check digit. It is IMPORTANT that this be accurate, as disbursements will be made according to this routing number.
a single number check digit. It is IMPORTANT that this be accurate, as disbursements will be made according to this routing number.
PS Form 1199-A, April 1986
PS Form 1199-A, April 1986
PS Form 1199-A, April 1986
PS Form 1199-A, April 1986
* U.S. GPO: 1986-0-159-625/5628
* U.S. GPO: 1986-0-159-625/5628
* U.S. GPO: 1986-0-159-625/5628
* U.S. GPO: 1986-0-159-625/5628
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