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  • 1199seiu Direct Deposit Form

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877) 557-1199 Direct Electronic Deposit Authorization (A minimum of four (4) weeks to put into effect) Print clearly in black or blue ink. Full Name: Member ID or Social Security #: Telephone: ( ) Address: City: State: Beneficiary Social Security # (if applicable): - Zip Code: - Election: You must sign and date this form to make any change (choose one) New Pension Direct Deposit Bank by Mail (For banks in foreign countries or banks that do not accept direct deposit. We will mail the c.

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Claim or Payroll ID Number: The form cannot be processed without this information. Enter your Federal Employer Identification Number. This is your 9-digit tax ID number, issued by the IRS. D. Check type of Bank Account - "Checking" or "Savings".

This is your 9-digit tax ID number, issued by the IRS. D. Check type of Bank Account - "Checking" or "Savings".

• (C) Claim or Payroll ID Number -This is your organization's 12 digit Entity Identification. Number (EIN) or your organization's 9-digit Tax Identification Number (TIN) or Social Security Number (SSN). For HHS Grant Recipients, this number is also found on your Notice of Grant Award (NGA) issued by the awarding agency ...

More than 200,000 members of 1199SEIU have won comprehensive healthcare coverage — hospitalization, doctors' visits, dental and vision care, prescription drugs, etc. — with no or minimal out-of-pocket expenses for themselves and their families. In all, the benefit covers more than 450,000 lives.

Do you have an 1199SEIU Member ID? Your Member ID is a ten-digit number beginning with "9" that appears on your Health Benefits ID card.

Your employer (or other payer) will ask you to complete a direct deposit form that will ask for several personal details, including your name, address, Social Security number and signature for authorization of the direct deposit. Include your account information.

CLAIMS SUBMISSION Submit the completed form by fax to (646) 473-7088, by email to MedicalRecon@1199Funds. org or by mail to 1199SEIU Benefit Funds, Medical Claims Reconsideration, PO Box 717, New York, NY 10108-0717.

All you need is your account number and routing number.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232