Maryland Direct Deposit Form 3Maryland Direct Deposit Form 3Maryland Direct Deposit Form 3
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Standard Form 1199A (EG)

OMB No. 1510-0007

(Rev. August 2012)
Prescribed by Treasury
Department
Treasury Dept. Cir. 1076

DIRECT DEPOSIT SIGN-UP FORM

DIRECTIONS
The claim number and type of payment are printed on Government
To sign up for Direct Deposit, the payee is to read the back of this form
checks. (See the sample check on the back of this form.) This
and fill in the information requested in Sections 1 and 2. Then take or
information is also stated on beneficiary/annuitant award letters and
mail this form to the financial institution. The financial institution will
other documents from the Government agency.
verify the information in Sections 1 and 2, and will complete Section 3.
The completed form will be returned to the Government agency
Payees must keep the Government agency informed of any address
identified below.
changes in order to receive important information about benefits and to
remain qualified for payments.
A separate form must be completed for each type of paymen