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Get SSA-1199-GR-OP1 2014-2021

Ete Section 1 and "SIGN YOUR NAME" - Ask your bank to complete Section 3 - Mail completed form back using address in Section 2 SECTION 1 (TO BE COMPLETED BY PAYEE) Name and Complete Mailing Address: SOCIAL SECURITY CLAIM NUMBER B.I.C Name of Person Entitled to the Benefits Telephone Number: Type PAYEE CERTIFICATION I certify that I have read and understand the back of this form. In signing this form, I authorize the Social Security Administration to send my payment to my bank and deposit.

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