Get VA 24-0296 2009

Whitehouse. gov/omb/library/OMBINV. VA. EPA. html VA. If desired you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form. VA FORM NOV 2009 24-0296 SUPERSEDES VA FORM 24-0296 FEB 2006 WHICH WILL NOT BE USED. To have your VA compensation pension education or spina bifida payment deposited into your account right away with Direct Deposit just call VA s tollfree number above or complete this form and mail to Department of Veterans Affairs 125 S. Main Street Suite B Muskogee OK 74401-7004 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. An example of a routine use is that the information will be used to process the payment data from VA to the beneficiary s designated financial institution. Your obligation to respond is voluntary. Please read the Privacy Act and Respondent Burden information shown below. ATTENTION VA BENEFICIARY WE VE MADE ENROLLING IN DIRECT DEPOSIT EASIER THAN EVER CALL TOLL FREE - 1-877-838-2778 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 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 tollfree number above or complete this form and mail to Department of Veterans Affairs 125 S. Main Street Suite B Muskogee OK 74401-7004 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. SECTION I - VA BENEFICIARY INFORMATION NAME OF BENEFICIARY Last First MI Please Print BENEFICIARY CLAIM NUMBER TYPE OF BENEFIT COMPENSATION PENSION EDUCATION CHAPTERS 30 33 1606 1607 National Call to Service CHAPTER 18 VA CLAIM NUMBER OR SOCIAL SECURITY NUMBER TELEPHONE NUMBER PLEASE PROVIDE YOUR TELEPHONE NUMBER IN THE EVENT THAT WE NEED TO CONTACT YOU INCLUDE AREA CODE DAYTIME TELEPHONE NUMBER EVENING TELEPHONE NUMBER SECTION II - FINANCIAL INSTITUTION INFORMATION PLEASE ATTACH A VOIDED PERSONAL CHECK AND SKIP TO SECTION III OR CALL YOUR FINANCIAL INSTITUTION FOR THE FOLLOWING INFORMATION ROUTING TRANSIT NUMBER ACCOUNT NUMBER PLEASE CHECK THE APPROPRIATE BOX CHECKING SAVINGS NAME OF FINANCIAL INSTITUTION ADDRESS OF FINANCIAL INSTITUTION SECTION III - 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. DATE SIGNED SIGNATURE OF PAYEE Do NOT print 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. 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. SECTION I - VA BENEFICIARY INFORMATION NAME OF BENEFICIARY Last First MI Please Print BENEFICIARY CLAIM NUMBER TYPE OF BENEFIT COMPENSATION PENSION EDUCATION CHAPTERS 30 33 1606 1607 National Call to Service CHAPTER 18 VA CLAIM NUMBER OR SOCIAL SECURITY NUMBER TELEPHONE NUMBER PLEASE PROVIDE YOUR TELEPHONE NUMBER IN THE EVENT THAT WE NEED TO CONTACT YOU INCLUDE AREA CODE DAYTIME TELEPHONE NUMBER EVENING TELEPHONE NUMBER SECTION II - FINANCIAL INSTITUTION INFORMATION PLEASE ATTACH A VOIDED PERSONAL CHECK AND SKIP TO SECTION III OR CALL YOUR FINANCIAL INSTITUTION FOR THE FOLLOWING INFORMATION ROUTING TRANSIT NUMBER ACCOUNT NUMBER PLEASE CHECK THE APPROPRIATE BOX CHECKING SAVINGS NAME OF FINANCIAL INSTITUTION ADDRESS OF FINANCIAL INSTITUTION SECTION III - 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. DATE SIGNED SIGNATURE OF PAYEE Do NOT print 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. .