Form 29-0309 Direct Deposit Enrollment/Change

OMB Approved No. 2900-0665
Respondent Burden: 20 minutes
Expiration Date: XX/XX/XXXX

DIRECT DEPOSIT ENROLLMENT/CHANGE
IMPORTANT: You can use this form to enroll in Direct Deposit or to make a change to an existing direct deposit account.
SECTION I - TO BE COMPLETED BY PAYEE

1. NAME AND ADDRESS

2. INSURANCE FILE NUMBER
3. SOCIAL SECURITY NUMBER (Must supply)

4. DAYTIME TELEPHONE NUMBER

I hereby authorize the Department of Veterans Affairs to start/change direct deposit at the financial institution stated in Item 7, for the
purpose of depositing directly into the account stated in Item 10, any and all Government Life Insurance payments that I am entitled to
receive from all insurance policies under the insurance file number shown in Item 2.
5. SIGNATURE

6. DATE

SECTION II - PLEASE ATTACH A VOIDED PERSONAL CHECK. IF YOU DO, SKIP ITEMS 7-10. IF YOU DO NOT
HAVE A CHECKING ACCOUNT, CONTACT YOUR BANK FOR HELP IN COMPLETING ITEMS 7-10.

NOTE: PLEASE PROVIDE A COPY OF THE POWER OF ATTORNEY IF YOU HAVE NOT ALREADY DONE SO. WHEN A POWER
OF ATTORNEY IS APPLYING FOR DIRECT DEPOSIT, A COPY OF A CHECK MUST BE SUBMITTED SHOWING THE INSURED'S
NAME ON THE ACCOUNT.

7. NAME OF BANK/FINANCIAL INSTITUTION

8. TELEPHONE NUMBER OF BANK/FINANCIAL INSTITUTION

10. BANK ACCOUNT NUMBER AND TYPE

9. BANK ROUTING NUMBER (9 DIGITS)

CHECKING
SAVINGS

The bank routing
number is always 9
digits and appears
between the |:
symbols.

SAMPLE CHECK

Customer Name
Street Address
City, State, ZIP

Check No. 1234

$

PAY TO THE
ORDER OF

Dollars

|:123456789|:

1617284958569678||:

1234

Bank Routing
Number

Bank Account
Number

Check Number
(Not needed)

The bank account
number varies in
length and may
contain dashes or
spaces. The
||: symbol indicates
the end of the account
number.

11. DO YOU PARTICIPATE IN VAMATIC (AUTOMATIC DEDUCTION OF MONTHLY INSURANCE PREMIUM FROM A CHECKING ACCOUNT)?
IF YES, DOES THIS CHANGE APPLY TO VAMATIC?
YES

NO

For an Insured:
VAROIC-DD
P.O. BOX 42954
PHILADELPHIA, PA 19101

MAIL THE COMPLETED FORM TO:
For a Beneficiary:
VAROIC-DD
P.O. BOX 7208
PHILADELPHIA, PA 19101-7208

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 identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S.
Government Life Insurance Records - VA, and published in the Federal Register. Your obligation to respond is voluntary, but your failure to provide us the information
could impede processing. Giving us your Social Security number (SSN) account information is mandatory. Applicants are required to provide their SSN. VA will not
deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1,
1975, and still in effect. The responses you submit are considered confidential (38 U.S.C. 5701).
RESPONDENT BURDEN: We need this information to ensure proper transmission of your funds via electronic transfer to your financial institution (31 CFR 208.3
and 210.4). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 20 minutes to review the instructions, find
the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not
required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at
www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

IF YOU HAVE ANY QUESTIONS ABOUT DIRECT DEPOSIT, PLEASE CALL OUR TOLL-FREE NUMBER 1-800-669-8477.
VA FORM
APR 2014

29-0309

SUPERSEDES VA FORM 29-0309, NOV 2010,
WHICH WILL NOT BE USED.