TN 29 (12-06)
GN 02402.075 Completion of the SF-1199A
Most direct deposit actions are taken without a form SF 1199A. However, forms may still be received in the FO for processing when a Financial Institution (FI) is the point of first contact with the claimant, or when the FO refers the claimant to the FI in those situations where the form is required. (See GN 02402.070B for situations where a completed, signed form is required.)
A separate form must be completed for each FI account and/or each type of benefit.
In postentitlement situations completed forms are retained in the FO for 3 months after processing, then destroyed. If a form is received with a claim, the electronic folder should be updated with the direct deposit information, receipted on the DW01 and then destroyed.
B. Description of Entries
The SF 1199A is displayed in http://www.ssa.gov/deposit/1199a.pdf .
1. Section 1
a. Block A -- Name of Payee
Print the name of:
b. Block B - Name of Person Entitled to Payment
Print the name of the claimant included in the request.
c. Block C -- Claim or Payroll ID Name
Print the SSN and Beneficiary Identification Code (BIC) or Individual Recipient Identification (ID) of the claimant.
d. Block D -- Type of Account
Place a checkmark in the appropriate box for a checking or savings account.
e. Block E -- Depositor Account Number (DAN)
Print the DAN (see GN 02402.035).
f. Block F -- Type of Payment
Indicate Social Security or Supplemental Security Income, as appropriate.
g. Block G -- Allotment Information
This block should not be completed, since SSA will only approve direct deposit of the full payment amount.
h. Signature Block -- Payee/Joint Payee Certification
This block must contain the signature of:
The claimant, or
The representative payee
i. Optional Signature Block -- Joint Account Holder's Certification
This block will usually not be completed. If it shows a signature of a person not shown in the depositor account title, check the accuracy of the account title.
2. Section 2
Ensure that the SF-1199A was completed for Social Security or Supplemental Security Income benefits.
3. Section 3
a. Name and Address of Financial Institution
Print the name and address of the FI.
b. Routing Number (RTN)
Print the RTN and appropriate check digit (see GN 02402.035).
c. Depositor Account Title
Print the exact title of the account (see GN 02402.050 for acceptable account titles).
d. Financial Institution Certification
This block should be completed and signed by a representative of the FI.