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Domestic Banking Information


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

Download the SF-1199A Direct Deposit Form

  • All information is to be typed or printed on the SF-1199A.
  • Alterations such as erasures, correction fluid and strike-outs are unacceptable and will invalidate the form.
  • If you are a new recipient, the Payment Management Access Form should accompany the SF-1199A

What is the purpose of this form?

The SF-1199A collects the information necessary for the Payment Management System (PMS) to have Federal funds electronically deposited into the recipient's bank account.

Who must complete this form?

Sections 1 and 2 of the form are to be completed by the recipient. Section 3 is to be completed by the recipient's financial institution.

Where do I send the form?

Regular Mail

HHS/PSC/Payment Management Services, Post Office Box 6021, Rockville, MD 20852

Express Mail

HHS/PSC/Payment Management Services, 7700 Wisconsin Avenue, 9th Floor, Bethesda, MD 20814

Fax

Governmental and Tribal Payments Section (301) 492-4511
University and Non-Profit Payment Section (301) 492-4571

* NON-DHHS Grant Recipients should contact their awarding agency to see if they need a copy of the form.

What if the bank information changes?

The recipient must obtain and complete a new SF-1199A. Blank forms are available on the PMS website at http://pms.psc.gov and should be available at the recipient's financial institution as well. Once all sections are completed, please include a cover memo stating that the accompanying SF-1199A form is being submitted to change account information in the Payment Management System. The memo should list all the Payee Account Numbers (PANS) that are affected.

Section 1 (To be Completed by Payee)

  1. TYPE OR PRINT YOUR ORGANIZATION'S NAME, ADDRESS AND TELEPHONE NUMBER. Do not enter an individual's name in this block. 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 Central Registry (CRS)/Entity Identification Number (EIN) or your organization’s 9-digit Tax Identification Number (TIN). For DHHS Grant Recipients, this number is also found on your Notice of Grant Award (NGA) issued by the 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 "Direct 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)

Type or print “Payment Management Services” & the address “Post Office Box 6021, Rockville, Maryland 20852”

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 should match the payee name in most cases. Notes: If “ALL” portions of this section are not completed, this will cause a delay in your organization being established in PMS. Your organization should maintain a copy of the form for its records.