Form AD-349 "Employee Address"

What Is Form AD-349?

This is a legal form that was released by the U.S. Department of Agriculture on December 1, 1993 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 1993;
  • The latest available edition released by the U.S. Department of Agriculture;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AD-349 by clicking the link below or browse more documents and templates provided by the U.S. Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download Form AD-349 "Employee Address"

Download PDF

Fill PDF online

Rate (4.3 / 5) 52 votes
Page background image
AGENCY USE
FORM AD-349
U.S. DEPARTMENT OF AGRICULTURE
(REV. 12/93)
EMPLOYEE ADDRESS
ACTION
AGENCY
EFFECTIVE
CODE
DATE
SECTION I
Complete Section I with your current or new residence mailing address. This address is used to
mail out employee Pay and TSP statements, W-2 forms and other personal documents.
NOTE: This form does not change the U.S. Savings Bond address.
1. NAME (Last, First, Middle)
2. SOCIAL SECURITY NO.
3. STREET ADDRESS OR P.O. BOX
4. APT NO.
5. CITY NAME
6. STATE or COUNTRY NAME
7. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
SECTION II
FOR EMPLOYEES WITH DIRECT DEPOSIT COMPLETE BLOCKS 13 AND 14 ONLY.
Employees who wish to receive their checks in the mail complete blocks 8 through 14 with
your current or new check mailing address.
8. STREET ADDRESS or P.O. BOX
9. APT NO.
10. CITY NAME
11. STATE or COUNTRY NAME
12. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
13. SIGNATURE OF EMPLOYEE
14. DATE SIGNED
Clear Form
AGENCY USE
FORM AD-349
U.S. DEPARTMENT OF AGRICULTURE
(REV. 12/93)
EMPLOYEE ADDRESS
ACTION
AGENCY
EFFECTIVE
CODE
DATE
SECTION I
Complete Section I with your current or new residence mailing address. This address is used to
mail out employee Pay and TSP statements, W-2 forms and other personal documents.
NOTE: This form does not change the U.S. Savings Bond address.
1. NAME (Last, First, Middle)
2. SOCIAL SECURITY NO.
3. STREET ADDRESS OR P.O. BOX
4. APT NO.
5. CITY NAME
6. STATE or COUNTRY NAME
7. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
SECTION II
FOR EMPLOYEES WITH DIRECT DEPOSIT COMPLETE BLOCKS 13 AND 14 ONLY.
Employees who wish to receive their checks in the mail complete blocks 8 through 14 with
your current or new check mailing address.
8. STREET ADDRESS or P.O. BOX
9. APT NO.
10. CITY NAME
11. STATE or COUNTRY NAME
12. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
13. SIGNATURE OF EMPLOYEE
14. DATE SIGNED
Clear Form
PRIVACY ACT NOTICE FOR AD-349, EMPLOYEE ADDRESS
General
This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals
completing Form AD-349.
Authority
5 USC 301.
Purpose and Uses
This form is used to obtain an employees home address and check mailing address.
Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b) (Privacy Act of
1974)
Disclosure by you of your Social Security Number (SSN) is mandatory to obtain the services, benefits, or processes that you
are seeking. Solicitation of the SSN by the United States Department of Agriculture is authorized under provisions of
Executive Order 9397, dated November 22, 1943. The SSN is used as an identifier throughout your Federal career from the
time of application through retirement. It will be used primarily to identify your records that you file with the U.S. Department
of Agriculture. The SSN also will be used by the U.S. Department of Agriculture and other Federal agencies in connection with
lawful requests for information about you from your former employers, educational institutions, and financial or other
organizations. The information gathered through the use of the number will be used only as necessary in personnel
administration processes carried out in accordance with established regulations and published notices of systems of records.
The SSN also will be used for the selection of persons to be included in statistical studies of personnel management matters.
The use of the SSN is made necessary because of the large number of present and former Federal employees and applicants
who have identical names and birth dates, and whose identifies can only be distinguished by the SSN.
Page of 2