Fillable Form Ssa-1199-Po-Op1 - Direct Deposit Sign-Up Form (Poland) (Page 2 of 3) 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 the financial institution in your country.

WHEN YOU WILL RECEIVE YOUR DIRECT DEPOSIT PAYMENTS

The banking system in the country where your account is located will process your benefit payment and should generally post

to your account on the regular payment date. However, delays in direct deposit can occur when a payment date falls on a

holiday in the country of the receiving bank. With direct deposit, you will have immediate access to your money. This is the

safest way of receiving your benefits.

INFORMATION ABOUT CURRENCY CONVERSION:

With direct deposit, your U.S. Social Security payment is automatically converted to U.S. Dollars (if applicable) at the daily

international exchange rate before deposited to your account.

**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 Social Security Administration or the American Embassy or Consulate in your area. Any Social

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

IF YOUR ADDRESS CHANGES:

If your address changes, you must inform the American Embassy or the Social Security Administration. If the

Social Security Administration needs to contact you and cannot locate you, your payments may be stopped.

CHANGING BANKS OR BANK ACCOUNTS:

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

American Embassy

Social Security Administration

Federal Benefits Unit

Office of Earnings and International Operations

ul. Piekna 12

PO Box 17769

00-539 Warszawa

Baltimore, MD 21235-7769

Poland

USA

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

have started coming to your new account.

Paperwork Reduction Act Statement

- This information collection 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. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. You

can find your local Social Security office through SSA's website at Offices are also listed under

U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213

(TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD

21235-6401. Send only comments relating to our time estimate to this address, not the completed form.

Form SSA-1199-PO-OP1 (09-2015)

Form Ssa-1199-Po-Op1 - Direct Deposit Sign-Up Form (Poland) Page 2