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You must complete a separate form for each type of federal
payment (social security, supplemental security income, veterans’ benefits, etc.).
You are responsible for keeping the paying agency informed of any name or address changes. Return the completed form to the federal agency from which you will be receiving Direct Deposit payments.
Your social security number and the other information requested will allow the federal government to make
payments to you by Direct Deposit. This collection of information is authorized by Title 31 of the United States
Code, Section 3332(g). Also, Executive Order 9397, November 22, 1943, authorizes the use of your social
security number.
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