Payment Management System
Program Support Center

International Banking Direct Deposit

Instructions for Completion of the Direct Deposit Sign-Up Form (SF-1199A) for International Grantees


Section 1 (To be Completed by Payee)

  1. TYPE OR PRINT YOUR ORGANIZATION'S NAME, ADDRESS AND TELEPHONE NUMBER. IF YOU ARE AN INDIVIDUAL RECEIVING A GRANT IN YOUR NAME, PLEASE TYPE OR PRINT YOUR NAME, ADDRESS AND TELEPHONE NUMBER.. Forms containing white out or any alterations to the payee name are unacceptable.
  2. LEAVE IT BLANK
  3. Claim or Payroll ID Number: The form cannot be processed without this information. This is your organization’s 12-digit PMS Employer Identification Number (EIN) or your organization’s 9-digit Tax Identification/Employer Identification Number (TIN/EIN). For Individuals, enter your SSN. For HHS Grant Recipients, this number can be found on your Notice of Grant Award issued by the HHS awarding agency.
  4. Check type of Bank account "Checking" or "Savings".
  5. TYPE THE ACCOUNT NUMBER at your Financial Institution to which the funds will be deposited. Do not use white out or make any alterations to the account number.
  6. Check the box "Other" and type the name of the awarding Federal agency.
  7. Leave blank.

Payee Account Holder’s Certification: The individual(s) having signature authority for the bank account should sign and date.


Section 2 (To be Completed By Payee)

For HHS Grant Recipients: Type or print “US Department of Health and Human Services” and the address “Post Office Box 6021, Rockville, Maryland 20852”.

For Non-HHS Grant Recipients: Type or print the name of the Awarding Agency and their address.


Section 3 (To be completed by your Financial Institution)

The bank’s representative must sign the form and provide a telephone number for contact purposes. The depositor account title must be filled in and match the payee name. Maintain a copy of the form for your records.


Other Required Information:

You must also include an International Bank Letter with the following information. Information must be on your International Bank Letterhead with authorized signatures. A sample letter has been provided as an example.

HHS GRANTEES MAY SEND DOCUMENTS USING ANY OF THE FOLLOWING METHODS:

Regular Mailing Address:

U.S. Department of Health and Human Services
Payment Management Services
Post Office Box 6021
Rockville, MD 20852

Overnight Mailing Address:

U.S. Department of Health and Human Services
Payment Management Services
7700 Wisconsin Avenue, 7th Floor
Bethesda, MD 20814

Fax:

301-492-4581

Email your organization's PMS Liaison Accountant:

NON-HHS GRANTEES SHOULD CONTACT THEIR AWARDING AGENCY FOR INSTRUCTIONS ON WHERE TO SEND FORMS, IF IT IS NOT STATED IN THE TERMS AND CONDITIONS OF THE AWARD.