

This collection of information is authorized by OMB Control No. The federal agency will then determine if the survivor is eligible for benefits.

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. 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. 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. 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. This information will be disclosed to the federal agencies involved in making federal payments to you by direct deposit. 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. Also, Executive Order 9397, November 22, 1943, authorizes the use of your Social Security number. This collection of information is authorized by Title 31 of the United States Code, Section 3332(g).

Your Social Security number and the other information requested will allow the federal government to make payments to you by direct deposit. 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. That is false to obtain information from Social Security Administration or other federal government records, and/orĢ. AcknowledgementĪny person who knowingly and willingly makes any representationġ. It begins with a heading 1 called “Acknowledgment”.
