OMB Approved No. 2900-0564
Respondent Burden: 15 Minutes
Expiration Date: 02/28/2019
DIRECT DEPOSIT ENROLLMENT
IMPORTANT: You can use this form to enroll in Direct Deposit or to make a change to an existing direct deposit account.
Please read the Privacy Act and Respondent Burden information shown below.
SUPERSEDES VA FORM 24-0296, MAY 2016,
WHICH WILL NOT BE USED.
8. TYPE OF BENEFIT
SECTION II: BENEFICIARY'S IDENTIFICATION INFORMATION
VA DATE STAMP
(DO NOT WRITE IN THIS SPACE)
ATTENTION VA BENEFICIARY!
WE'VE MADE ENROLLING IN DIRECT DEPOSIT EASIER THAN EVER!
CALL TOLL FREE - 1-800-827-1000
or TDD 1-800-829-4833 (Telephone Device for the Hearing Impaired)
Direct Deposit is the safest, fastest and most cost efficient method to receive your payment. In
addition, you no longer have to worry about your check being late, lost, or stolen. NOTE: The
"Debt Collection Improvement Act of 1996" which was signed into law on April 26, 1996 required
all Federal payments to be made by Electronic Fund Transfer (EFT or Direct Deposit) beginning
January 1, 1999. Waivers will be available where the conversion from paper checks imposes a
hardship. Write to the address shown below for more information concerning a waiver. To have
your VA compensation, pension, education, or spina bifida payment deposited into your account
right away with Direct Deposit just call VA's toll-free number above or complete this form and
Department of Veterans Affairs
125 S. Main Street Suite B
Muskogee OK 74401-7004
SECTION I: VETERAN'S IDENTIFICATION INFORMATION
When you call, be sure to have a personal check or bank statement available as well as your VA Claim
Number or Social Security Number. The VA representative will ask for information from these
documents to start your Direct Deposit. If you prefer to enroll by mail, just complete the information
below, and attach a voided personal check from your checking account or call your Financial Institution
and verify the information requested below for a savings account.
NOTE: You can either complete the form online or by hand. Please print the information requested in ink, neatly and legibly to help process the form.
1. VETERAN'S NAME (First, Middle Initial, Last)
2. SOCIAL SECURITY NUMBER 3. VA FILE NUMBER
4. DATE OF BIRTH (MM/DD/YYYY)
5. BENEFICIARY'S NAME (First, Middle Initial, Last - If other than veteran)
6. SOCIAL SECURITY NUMBER 7. VA FILE NUMBER
9. ADDRESS OF PERSON RECEIVING PAYMENT (Check box if new )
SECTION III: FINANCIAL INSTITUTION INFORMATION
PLEASE ATTACH A VOIDED PERSONAL CHECK AND SKIP TO SECTION III OR CALL YOUR FINANCIAL INSTITUTION FOR THE FOLLOWING
10. ROUTING TRANSIT NUMBER
11. ACCOUNT NUMBER (Please check the appropriate box) SAVINGS
12. NAME OF FINANCIAL INSTITUTION
13. ADDRESS OF FINANCIAL INSTITUTION
14. TELEPHONE NUMBER OF FINANCIAL INSTITUTION
(Include Area Code)
SECTION IV: PAYEE CERTIFICATION
I CERTIFY THAT I am entitled to the payment above, and that I have read and understand this form. In signing this form, I authorize my payment to be sent to the
financial institution named above, to be deposited to the designated account.
16. DATE SIGNED15. SIGNATURE OF PAYEE (Do NOT print - Sign in ink) 17. TELEPHONE NUMBER
(Include Area Code)
Privacy Act Notice: VA will not disclose information collected on this form to any source
other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of
Federal Regulations 1.576 for routine uses as identified in the VA system of records,
58VA21/22/28, Compensation, Pension, Education, Vocational Rehabilitation and
Employment Records - VA, published in the Federal Register. Your obligation to respond
is voluntary. The information solicited under authority of Title 31 Code of Federal
Regulations, Section 210.4 will be used to process the payment data from VA to your
account at the designated financial institution. Giving us your Social Security Number
(SSN) is mandatory. Applicants are required to provide their SSN under Title 38, U.S.C.
5101 (c) (1). VA will not deny an individual benefits for refusing to provide his or her
SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior
to January 1, 1975, and still in effect. The requested information is considered relevant
and necessary to determine maximum benefits provided by law. The responses you submit
are considered confidential (38 U.S.C. 5701).
Respondent Burden: We need this information to ensure proper transmission of your
funds via electronic transfer to your financial institution (31 CFR 208.3 and 210.4). Title
38, United States Code, allows us to ask for this information. We estimate that you will
need an average of 15 minutes to review the instructions, find the information, and
complete this form. VA cannot conduct or sponsor a collection of information unless a
valid OMB control number is displayed. You are not required to respond to a collection of
information if this number is not displayed. Valid OMB control numbers can be located
on the OMB Internet Page at
. If desired, you can call 1-800-827-1000 to get
information on where to send comments or suggestions about this form.