List of Variable Information We May Request on Form SSA-1199-(Country)

Bank Data in Section 3 of the SSA-1199

We use the SSA-1199 International Direct Deposit (IDD) form to sign up individuals to receive direct deposit of Title II SSA benefits abroad. Currently, every country eligible for IDD has an associated SSA-1199 form. Due to the number of countries eligible for IDD, there are 58 versions of the form. The questions in section 1 of each form remain the same. However, there are variations in the requested bank data information in the bottom portion of section 3. The variations in requested bank data depend on the country for which the form is associated.

Countries enrolled in IDD can request a unique combination of the following bank data items in section 3 for the purpose of IDD processing:

• Account Number

• Bank Number/Code

• Bank Sorting Code

• Bank State Branch Number/Code

• Branch Number/Code

• Canadian Account Number

• Check Char (CIN)

• Check Digit Code

• Control Code

• Country Code

• Debit Card Number

• Deposit Account Number (DAN)

• Institution Code

• International Bank Account Number (IBAN)

• Locality

• Mexican Bank Association (ABM) number

• Routing and Transit Number (RTN)

For the OMB clearance package, we are providing a generic SSA-1199 with the most common requested bank information included. We are also providing an example of the Canadian SSA-1199.