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

IMPORTANT INFORMATION - PLEASE READ CAREFULLY

The information you give on this form is confidential. We need the information to send your U.S. Social

Security payments electronically to your bank account in Israel.

WHEN YOU WILL RECEIVE YOUR DIRECT DEPOSIT PAYMENTS

Your payment will be sent electronically through the Bank of Scotland to your financial institution in Israel, and

will usually be in your Shekel account at your financial institution in Israel the day after the U.S. payment date.

You can avoid waiting for your check to clear. With direct deposit you will have immediate access to your

money.

HOW INTERNATIONAL DIRECT DEPOSIT SAVES YOU MONEY

With direct deposit, you will not need to pay any check cashing fees. Your benefits will be sent electronically

to your Shekel account in your Israeli financial institution. You will not need to pay a conversion fee to get your

payment in Shekels. Your U.S. Social Security payment will be automatically converted to Shekels at a good

rate the day before it is deposited into your account.

IF YOUR ADDRESS CHANGES

If your address changes, you must inform the U.S. Social Security Administration because letters about your

payments will still be mailed to your home address. If we cannot locate you, your payments may be stopped.

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

If you have a joint account with a person who receives Social Security payments, and that person dies, you

must immediately contact your bank and the U.S. Social Security Administration. Any Social Security

payments deposited into a joint account after the death of a beneficiary must be returned to Social Security.

As soon as we are advised of the death, if you are eligible to receive Social Security, we will determine

whether your benefit amount will change and will send you any money that we owe you.

IF YOU HAVE QUESTIONS

If you have questions, you may contact the Federal Benefits Unit at one of these addresses:

American Embassy

American Consulate General

Federal Benefits Unit

PO Box 290

71 Hayarkon St.

18 Agron Rd.

Jerusalem Israel 91002

Tel Aviv 63903

Jerusalem 94190

CHANGING BANKS OR BANK ACCOUNTS

If you change your bank or your account, you must notify one of the offices above, or the following:

Social Security Administration

Office of International Operations

PO Box 17769

Baltimore, MD 21235-7769

You may need to fill out a new sign-up form. Do not close your old account until payments have started

coming to your new account.

PAPERWORK REDUCTION ACT STATEMENT

This information meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork

Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of

Management and Budget control number. We estimate that it will take about 5 minutes to read the

instructions, gather the facts, and answer the questions. You may send comments on our time estimate above

to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Only comments relating to our time estimate

should be provided, not the completed form.

Form SSA-1199-OP14 (07/2007)

Direct Deposit Sign-Up Form Page 2

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