Enrollment Summary

Below is a summary of your enrollment. Once you “Enroll” we will begin to validate your enrollment. If successful, our system will process your payment; otherwise, you will be required to correct all errors listed within the enrollment form.

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Enrollment Review

Please correct your enrollment. You must correct all errors listed within the enrollment form.

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Acknowledgement

Any person who knowingly and willingly makes any representation

1. That is false to obtain information from Social Security Administration or other federal government records, and/or

2. That is intended to deceive the Department of the Treasury, Social Security Administration, or other federal agencies as to the true identity of the individual, could be punished by a fine or imprisonment, or both.

Privacy Act Notice

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. Your Social Security number is requested to ensure the accurate identification and retention of records pertaining to you and to distinguish you from other recipients of federal payments. This information will be disclosed to the federal agencies involved in making federal payments to you by direct deposit. This information may also be disclosed to a court, congressional committee or another government agency as authorized or required by federal law and to your financial institution to verify receipt of your federal payments. Although providing the requested information is voluntary, the Treasury will be unable to process your direct deposit enrollment application if you fail to provide the information.

Special Notice to Joint Account Holders

If your account is a joint account and receives direct deposit benefit payments, you must inform the federal agency and the financial institution of the death of the beneficiary. Payments sent by direct deposit after the date of death or ineligibility of a beneficiary (except for salary payments) must be returned to the federal agency. The federal agency will then determine if the survivor is eligible for benefits.

Paperwork Reduction Act Notice

This collection of information is authorized by OMB Control No. 1510-0007. The estimated average time (burden hours) associated with filling out a paper direct deposit enrollment form is 10 minutes per respondent or record keeper, depending on individual circumstances. The estimated average time for completing a direct deposit enrollment online is approximately five minutes.

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Verifying

Please be patient while the system validates your enrollment.

Inactivity Timeout

Due to inactivity, your session will terminate in:

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Security Notice Warning

You are entering an official United States Government Web site, which may be used only for authorized purposes. If you provide information through this Web site for an unauthorized purpose, or attempt to upload information and/or change any information stored on this Web site without authorization, or use this system for any other fraudulent or unlawful purpose, you may be subject to prosecution for violations punishable by imprisonment and/or other penalties under title 18, United States Code, Sections 1028 and 1030.

When you save your enrollment information your IP address will be captured.

The Government may monitor and audit the usage of this system. All persons are hereby notified that the use of this system constitutes consent to such monitoring and auditing.

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Are You Sure

Are you sure you want to cancel this enrollment? All information entered will be lost.

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