AGENCY:
DIRECT DEPOSIT SIGN-UP FORM FOR
TRAVEL PAYMENTS
CFTC
CPSC
FRA
FTA
OST
OSTWCF
RITA
STB
FAA
IMLS
MARAD
VOLPE
FHWA
GAO
OIG
SEC
FMCSA
NHTSA
PHMSA
NCUA
NAME(LAST, FIRST, MIDDLE INITIAL)
MAILING ADDRESS
CITY, STATE, ZIP
EMAIL ADDRESS
TELEPHONE NUMBER:
WORK
CELL
TYPE OF ACCOU
CHECKING
NT
SAVINGS
ROUTING TRANSIT NUMBER (This number appears at the extreme bottom left of your checks.
For savings accounts, you need to contact your financial institution.)
ACCOUNT NUMBER
NAMES ON ACCOUNT
FINANCIAL INSTITUTION'S NAME
AUTHORIZATION
(EMPLOYEE'S SIGNATURE)
(DATE)
All information on this form is required under 31 CFR 209 and/or 201. The information is voluntary, confidential and is needed to prove entitlement to payments. The
information will be used to process payments data from the Federal Aviation on to the financial institution and/or its agent. Failure to provide the requested information
may affect the processing of this form and may delay or prevent the receipt of payments through the Direct Deposit for Travel Payments.
Federal Aviation Administration
Mike Monroney Aeronautical Center
PCS Travel Branch, AMK-343
P.O. Box 25082
Oklahoma City, OK 73125-4913
FAX 405-954-4340
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