Form 1199-FR "Direct Deposit Sign-Up Form (France)"

What Is Form 1199-FR?

This is a legal form that was released by the U.S. Social Security Administration on July 1, 2012 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2012;
  • The latest available edition released by the U.S. Social Security Administration;
  • 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 1199-FR by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.

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Download Form 1199-FR "Direct Deposit Sign-Up Form (France)"

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Social Security Administration
Form Approved
OMB No. 0960-0686
DIRECT DEPOSIT SIGN-UP FORM (France)
APPLICATION FOR PAYMENT OF UNITED STATES SOCIAL SECURITY
MONTHLY BENEFITS BY DIRECT DEPOSIT
- Complete Section 1 and "SIGN YOUR NAME"
- Ask your bank to complete Section 3
- Mail completed form back using address in Section 2
SECTION 1 (TO BE COMPLETED BY PAYEE)
Name and Complete Mailing Address:
SOCIAL SECURITY CLAIM NUMBER
B.I.C
Name of Person Entitled to the Benefits
Telephone Number:
THIS BOX IS FOR ALLOTMENT OF PAYMENT ONLY (if applicable)
Type
Amount
PAYEE CERTIFICATION
JOINT ACCOUNT HOLDER'S CERTIFICATION (optional)
I certify that I have read and understand the back of this form.
I certify that I have read and understand the back of this form, including the
In signing this form, I authorize the Social Security Administration to send my
SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.
payment to my bank and deposit it in the designated account. I understand
that personal information in these payments will be treated confidentially, but I
consent to disclosure of payment information that is compelled by law or
necessary to protect against fraud or crime.
Your Signature
Date
Signature
Date
This account is:
My own account
A joint account
SECTION 2 (MAILING ADDRESS)
GOVERNMENT AGENCY NAME:
MAIL COMPLETED FORMS TO:
Social Security Administration
Office of International Operations
SOCIAL SECURITY ADMINISTRATION
PO Box 17769
Baltimore, MD 21235-7769
USA
SECTION 3 (TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION)
THIS ACCOUNT MUST BE IN EURO
Name of Bank
Bank Phone Number
(Nom de la banque)
(Numero de telephone de la banque)
Address of Bank
(Adresse de la banque)
Print Name of Bank Official
Signature of Bank Official
Bank Code
Branch Code
Account Number
(Code Banque)
(Code Guichet)
(Numero de Compte)
Form SSA-1199-FR (07/2012)
Social Security Administration
Form Approved
OMB No. 0960-0686
DIRECT DEPOSIT SIGN-UP FORM (France)
APPLICATION FOR PAYMENT OF UNITED STATES SOCIAL SECURITY
MONTHLY BENEFITS BY DIRECT DEPOSIT
- Complete Section 1 and "SIGN YOUR NAME"
- Ask your bank to complete Section 3
- Mail completed form back using address in Section 2
SECTION 1 (TO BE COMPLETED BY PAYEE)
Name and Complete Mailing Address:
SOCIAL SECURITY CLAIM NUMBER
B.I.C
Name of Person Entitled to the Benefits
Telephone Number:
THIS BOX IS FOR ALLOTMENT OF PAYMENT ONLY (if applicable)
Type
Amount
PAYEE CERTIFICATION
JOINT ACCOUNT HOLDER'S CERTIFICATION (optional)
I certify that I have read and understand the back of this form.
I certify that I have read and understand the back of this form, including the
In signing this form, I authorize the Social Security Administration to send my
SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.
payment to my bank and deposit it in the designated account. I understand
that personal information in these payments will be treated confidentially, but I
consent to disclosure of payment information that is compelled by law or
necessary to protect against fraud or crime.
Your Signature
Date
Signature
Date
This account is:
My own account
A joint account
SECTION 2 (MAILING ADDRESS)
GOVERNMENT AGENCY NAME:
MAIL COMPLETED FORMS TO:
Social Security Administration
Office of International Operations
SOCIAL SECURITY ADMINISTRATION
PO Box 17769
Baltimore, MD 21235-7769
USA
SECTION 3 (TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION)
THIS ACCOUNT MUST BE IN EURO
Name of Bank
Bank Phone Number
(Nom de la banque)
(Numero de telephone de la banque)
Address of Bank
(Adresse de la banque)
Print Name of Bank Official
Signature of Bank Official
Bank Code
Branch Code
Account Number
(Code Banque)
(Code Guichet)
(Numero de Compte)
Form SSA-1199-FR (07/2012)
IMPORTANT INFORMATION - PLEASE READ CAREFULLY
The Information you give on this form is confidential. We need the information to send your U.S. Social Security payments
electronically to the financial institution in your country.
WHEN YOU WILL RECEIVE YOUR DIRECT DEPOSIT PAYMENTS
The banking system in the country where your account is located will process your benefit payment and should generally post
to your account on the regular payment date. However, delays in direct deposit can occur when a payment date falls on a
holiday in the country of the receiving bank. With direct deposit, you will have immediate access to your money. This is the
safest way of receiving your benefits.
INFORMATION ABOUT CURRENCY CONVERSION:
With direct deposit, your U.S. Social Security payment is automatically converted (if applicable) to the currency of the country in
which your account is in at a good exchange rate a few days before your payment date.
**SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS**
If you have a joint account with a person who receives Social Security payments, and that person dies, you must immediately
contact your bank and the Social Security Administration or the American Embassy or Consulate in your area. Any Social
Security payments deposited into a joint account after the death of a beneficiary must be returned to Social Security.
IF YOUR ADDRESS CHANGES:
If your address changes, you must inform the American Embassy or the Social Security Administration. If the Social Security
Administration needs to contact you and cannot locate you, your payments may be stopped.
CHANGING BANKS OR BANK ACCOUNTS:
If you change your bank or your account, you must notify one of the following offices:
Social Security Administration
American Consulate
Office of American Services
Office of International Operations
Federal Benefits Unit
PO Box 17769
2 Rue St. Florentin
Baltimore, MD 21235-7769
75382 Paris Cedex 08
USA
France
You may need to fill out a new Direct Deposit sign-up form. Do not close your old account until payments
have started coming to your new account.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended
by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid
Office of Management and Budget control number. We estimate that it will take about 5 minutes to read the instructions, gather
the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY
OFFICE. You can find your local Social Security office through SSA's website at www.socialsecurity.gov. Offices are
also listed under U. S. Government agencies in your telephone directory or you may call Social Security at
1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd,
Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.
Form SSA-1199-FR (07/2012)
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