Form 29-0759 Suspension of Monthly Check

In Reply Refer to:
File Number:

Dear Policyholder:
We have suspended payment of your monthly insurance checks. The Department of the Treasury has informed us
that your check was not cashed within one year from the issue date. They have cancelled the check and forwarded
the funds to us. If you still have that check, please destroy it. You must complete and return this letter before we can
take further action.
The check was returned because
If the payee is deceased, please provide the date of death in Item 8 below.

.
OMB Approved No.: 2900-0635
Respondent Burden: 10 minutes
Expiration Date: XX/XX/20XX

SUSPENSION OF MONTHLY INSURANCE CHECK
The Department of the Treasury requires all Federal benefit payments be made by electronic funds transfer (EFT), also called direct deposit.
To enroll in direct deposit, provide the information requested below in Items 2A, 2B and 2C. If you do not have a bank account, please visit
https://www.benefits.va.gov/benefits/banking.asp. This website provides information about the Veterans Benefits Banking Program (VBBP), and a link
to banks and credit unions that may fit your needs. You may also call 1-800-827-1000. If you elect not to enroll, you must contact representatives
handling waiver requests for the Department of the Treasury at 1-888-224-2950. They will encourage your participation in EFT and address any
questions or concerns you may have.

2. U.S. BANK ACCOUNT
A. BANK NAME

1. HOME ADDRESS (Number and street or rural route, P.O. Box,

City, State, and ZIP Code)

B. TRANSIT/ROUTING NUMBER

3. DATE OF BIRTH (MM/DD/YYYY)

C. CHECKING OR SAVINGS ACCOUNT NUMBER

4. SOCIAL SECURITY NO.

5. DAYTIME TELEPHONE NUMBER (Include Area Code)
6. SIGNATURE (DO NOT PRINT)

D. TYPE OF ACCOUNT
CHECKING
SAVINGS

7. DATE SIGNED

(MM/DD/YYYY)

8. DATE OF DEATH (MM/DD/YYYY)

(If Payee is deceased)

PRIVACY ACT INFORMATION: 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, 36VA29, Veterans and Uniformed
Services Personnel Programs of U.S. Government Life Insurance - VA, and published in the Federal Register. Your obligation to respond is voluntary. VA uses
your SSN to identify your insurance file. Providing your SSN will help ensure that your records are properly associated with your insurance file. Giving us your
SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The 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.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. The OMB control number for this project is 2900-0635, and it expires XX/XX/20XX. Public reporting burden for this
collection of information is estimated to average 10 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other
aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance Officer at VACOPaperworkReduAct@va.gov.
Please refer to OMB Control No. 2900-0635 in any correspondence. Do not send your completed VA Form 29-0759 to this email address.

The fastest and most secure way for insureds and beneficiaries to send the
application to VA Insurance is to use the document upload service at:
https://insurance.va.gov/home/IDU

Or mail to: VA Insurance Center P.O. Box 7208
Philadelphia, PA 19101

If you have any questions or if the payee is incapable of conducting his/his own affairs, please call the toll-free number below.
Questions about your insurance? Call us toll-free at 1-800-699-8477. The best days to call are Wednesday and Thursday. Operators are on
duty Monday through Friday 8:30 AM to 6:00 PM Eastern Time.
VA FORM
XXX XXXX

29-0759

SUPERSEDES VA FORM 29-0759, DEC 2021,
WHICH WILL NOT BE USED.