Form Navpers 7430/1 - Electronic Funds Transfer Data Sheet

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FILLABLE FORM
SUPPORTING DIRECTIVE BUPERINST 1001.39
ELECTRONIC FUNDS TRANSFER
DATA SHEET
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. Departmental Regulations, Title 10 United States Code, Chapter 11.
PURPOSE: This information will be used to assist in the processing of your request for electronic funds transfer.
ROUTINE USES: To designate DOD personnel in carrying out the electronic funds transfer request action.
DISCLOSURE: Completion of the form is mandatory. Failure to provide required information may result in delay in response to, or disapproval. of your
request.
1. NAME
:
2. SOCIAL SECURITY NUMBER:
(LAST NAME, FIRST NAME, MIDDLE INITIAL)
3. ADDRESS:
4. DAYTIME TELEPHONE NUMBER:
5. ALTERNATE TELEPHONE NUMBER:
6. BANK:
7. BANK ACCOUNT NUMBER:
8. ACCOUNT TYPE
:
(PLEASE CHECK ONE)
9. BANK ROUTING NUMBER
:
(9 DIGITS)
CHECKING
SAVINGS
10. BAH STATUS (PLEASE CHECK ONE):
11. DATE OF BIRTH FOR DEPENDENT CHILDREN
DEPENDENT CHILD
SINGLE
MARRIED
10. BAH STATUS (PLEASE CHECK ONE):
13. FITW NUMBER OF EXEMPTIONS:
SINGLE
MARRIED
15. IF YOU PAY STATE INCOME PLEASE CHECK ONE:
14. STATE OF LEGAL RESIDENCE:
SITW
MARITAL STATUS
:
(WITHHOLDING)
(PLEASE CHECK ONE)
SINGLE
MARRIED
SITW NUMBER OF EXEMPTIONS:
COMPLETE AND RETURN THIS FORM TO:
NAVY PERSONNEL COMMAND
PERS-93
5722 INTEGRITY DRIVE, BLDG 768
MILLINGTON, TN 38054-0002
FAX NUMBER: (901) 874-2671
E-MAIL: PERS-9_IRR@navy.mil
NAVPERS 7430/1 (04-07)
FOR OFFICIAL USE ONLY
S/N: 0106-LF-981-1900
PRIVACY SENSITIVE
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