Social Security Direct Deposit Authorization Form 1200

Information you will need

• What’s the payee’s full name?
• What’s the account type?
• What’s the bank account number?
• What’s the payee’s city?
• What’s the payee’s state?
• What’s the payee’s address?
• What’s the payee’s zip code?
• What’s the area code for the payee’s phone number?
• What type of payment is the direct deposit for?
• What’s the claim number? (if applicable)
• What's the depositor account title?
• What are the first three digits of the payee’s phone number?
• What are the last four digits of the payee’s phone number?
• What’s the payee’s representative's full name? (if applicable)
• Does the payee have a representative?
• What’s the routing number?
• What are the middle 2 digits of the payee’s social security number (SSN)?
• What are the last 4 digits of the payee’s social security number (SSN)?
• What are the first 3 digits of the payee’s social security number (SSN)?
• What’s the most recent check number? (if applicable)
• What’s the dollar amount of most recent payment? (if applicable)
• What’s the cents column of the most recent payment?

Completed by the beneficiary and the recipient.