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Get VA 20-572 1996

13. SIGNATURE OF VETERAN OR PAYEE Do not print VA FORM MAR 1996 20-572 14. DATE SUPERSEDES VA FORM 572 OCT 1993 WHICH WILL NOT BE USED. REQUEST FOR CHANGE OF ADDRESS/CANCELLATION OF DIRECT DEPOSIT NOTE To notify the Department of Veterans Affairs of a change in address cancellation of direct deposit or both complete this form and mail it to the VA office having your records. The information is requested under Title 38 United States Code and will help insure that VA correspondence and any VA benefit checks to which you may be entitled are sent to your correct address. Disclosure is voluntary. However if the information is not furnished your mail may be lost or delayed and benefit payments if any may be suspended* Failure to furnish this information will have no other adverse effect on any benefit to which you may be entitled* The information may be disclosed outside VA as permitted by law or as stated in the Notices of Systems of VA Records which have been published in the Federal Register in accordance with the Privacy Act of 1974. 1. I AM REQUESTING Check appropriate box A CHANGE OF MY RESIDENCE ADDRESS 2. I AM RECEIVING BENEFITS AS THE Check appropriate box BOTH CHILD OTHER Specify FIDUCIARY 5. PAYEE NO. Type or print 4. VETERAN S SOCIAL SECURITY NO. 6. BENEFIT TYPE Check the benefit or benefits affected COMPENSATION OR PENSION SURVIVING SPOUSE MOTHER 3. VA FILE NO. Include letter prefix if any WIFE/HUSBAND FATHER A CANCELLATION OF MY DIRECT DEPOSIT ACCOUNT VETERAN CHAPTER 32 VEAP CHAPTER 35 DEA EDUCATION CHAPTER 30 CHAPTER 1606 Montgomery G*I. Bill-Active Voc* Rehab. 9. NAME OF PAYEE AS SHOWN ON CHECK Type or print 7. INSURANCE NO S Only give these numbers if you are receiving payments on the insurance policy of a deceased veteran 8. TYPE OF ADDRESS CHANGE Complete if applicable PERMANENT TEMPORARY 10. FIRST NAME-MIDDLE INITIAL-LAST NAME OF VETERAN 11. NEW ADDRESS Check only if applicable NUMBER AND STREET OR RURAL ROUTE Include Apartment Number if appropriate TELEPHONE NUMBER Include Area Code DAYTIME CITY STATE EVENING ZIP CODE 12. TO BE COMPLETED BY DIRECT DEPOSIT PARTICIPANTS ONLY If your benefit payment is currently being sent to a financial organization but you want it cancelled and sent to your home address check this box. Your payments will continue to be sent to the financial organization until the cancellation is processed* DO NOT close your bank account until your first payment is received at your home address. REQUEST FOR CHANGE OF ADDRESS/CANCELLATION OF DIRECT DEPOSIT NOTE To notify the Department of Veterans Affairs of a change in address cancellation of direct deposit or both complete this form and mail it to the VA office having your records. The information is requested under Title 38 United States Code and will help insure that VA correspondence and any VA benefit checks to which you may be entitled are sent to your correct address. The information is requested under Title 38 United States Code and will help insure that VA correspondence and any VA benefit checks to which you may be entitled are sent to your correct address. Disclosure is voluntary. However if the information is not furnished your mail may be lost or delayed and benefit payments if any may be suspended* Failure to furnish this information will have no other adverse effect on any benefit to which you may be entitled* The information may be disclosed outside VA as permitted by law or as stated in the Notices of Systems of VA Records which have been published in the Federal Register in accordance with the Privacy Act of 1974. .

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