Fillable International Direct Deposit Enrollment Form (Page 2 of 2) in pdf

PLEASE READ THIS CAREFULLY

PRIVACY ACT NOTICE

IF YOUR ADDRESS CHANGES

Your social security number and the other informa-

If your address changes, you must inform the U.S.

tion requested will allow the federal government to

government agency that issued the payment. If the

make payments to you by electronic funds transfer.

agency needs to contact you and cannot locate you,

This collection of information is authorized by Title

your payment may be stopped.

31 of the United States Code, Section 3332(g). Also,

Executive Order 9397, November 22, 1943, author-

CHANGING BANKS OR BANK ACCOUNTS

izes the use of your social security number. Your

If you change your bank or your account number,

social security number is requested to ensure the

you must notify the U.S. government agency that

accurate identification and retention of records

issues your payments.

pertaining to you and to distinguish you from other

federal recipients.

You may need to fill out a new sign-up form. Do not

close your old account until payments have started

This information will be disclosed to the Department

coming to your new account.

of the Treasury or another disbursing official to

process federal payments to you by electronic funds

BURDEN ESTIMATE STATEMENT

transfer. This information may also be disclosed to a

court, congressional committee or another govern-

The estimated average burden associated with this

ment agency as authorized or required by federal

collection of information is 10 minutes per respon-

law and your financial institution to verify receipt of

dent or record keeper, depending on the individual

your federal payments. Although providing the

circumstances. Comments concerning the accuracy

requested information is voluntary, a federal law

of this burden estimate and suggestions for

may require that you receive your federal payments

reducing this burden should be directed to the

by electronic funds transfer. If so, failure to provide

Financial Management Services, Facilities

any part of the requested information may delay or

Management Division, Administrative Programs

prevent the federal government from making

Division, Records and Information Management

payments to you.

Program, 3700 East-West Highway, Hyattsville, MD

20782. This address should only be used for

SPECIAL NOTICE TO JOINT ACCOUNT

comments and/or suggestions concerning the

HOLDERS

amount of time spent to collect the data. Do not

send the completed paperwork to the address

If your receiving bank and issuing agency allow a

above for processing.

joint account with a person who receives U.S. gov-

ernment issued payment(s) and that person dies,

you must immediately contact your bank and the

American Embassy/Consulate in your country

and/or the U.S. government agency that issued the

payment. Any U.S. government payment deposited

into a joint account after the death of a recipient

must be returned to the agency that issued the

payment.

International Direct Deposit Enrollment Form Page 2

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