FS Form 5512 Bank Change Request

For official use only:
Customer Name	     	Customer No.	     

FS Form 5512 Department of the Treasury Bureau of the Fiscal Service (Revised September 2015)

TreasuryDirect®

BANK CHANGE REQUEST

OMB No. 1535-0138 www.treasurydirect.gov 844-284-2676 (toll free)

IMPORTANT: Follow instructions in filling out this form. You should be aware that the making of any false, fictitious, or fraudulent claim or statement to the United States is a crime that is punishable by fine and/or imprisonment.

Use this form to add (or edit) bank information in your TreasuryDirect account.

1. TREASURYDIRECT ACCOUNT INFORMATION
TreasuryDirect Account Number:				     
TreasuryDirect Account Name:				     
				     
Taxpayer Identification Number (SSN/EIN):				     
	Please apply this information to all of my TreasuryDirect accounts.
	Please apply this information to the TreasuryDirect accounts listed below:
(Account Numbers of Other Primary Accounts or Custom, Conversion, or Minor Linked Accounts to Which the Bank Information Should be Added)				     
				     

2. ADD (EDIT) BANK INFORMATION Provide the bank account you want added to your TreasuryDirect account(s). If you want to edit any bank account information already listed in your TreasuryDirect account(s), such as correcting an account or routing number, complete all of the following fields as if you were adding a new bank account. We will add all of the information as a new bank account. You can then access your TreasuryDirect account and delete the unwanted bank account.
Please add the following bank information to my TreasuryDirect account:
Bank Name:		     
Routing Number:		     
Account Number:		     
Name(s) on Account:		     
Account Type:		Checking Savings
	Make this my Primary Bank information for purchases and payments.

Complete the following if you want to add another bank to your TreasuryDirect account:
Bank Name:	     
Routing Number:	     
Account Number:	     
Name(s) on Account:	     
Account Type:	Checking Savings
You will receive an e-mail once we have added the bank account(s) to your TreasuryDirect account.
KEEP PAGE 4 OF THIS FORM FOR REFERENCE It contains instructions for deleting an unwanted bank account changing the source of funds on pending purchases changing the payment destination for interest and/or maturity payments

3. SIGNATURES AND CERTIFICATIONS

Under penalties of perjury, I certify that the information provided on this form is true, correct, and complete. I certify that I have the authority to authorize financial transactions using the bank information described on this form. This request is submitted pursuant to the applicable provisions of 31 CFR Parts 353, 356, 357, 360, and 363. I agree to indemnify and hold the United States harmless in the event of any loss that results from this request.

	You must wait until you are in the presence of a certifying officer to sign this form. Certifying officers are available at banks, trust companies, and credit unions. Certification by a notary public is NOT acceptable.
Sign Here:				     
		(Signature)			(Daytime Telephone No.)
		     
		(Number and Street or Rural Route, City, State, and ZIP Code)

Certifying Officer:

The individual must sign in your presence and you must complete the certification and affix your stamp or seal. Acceptable certifications include the financial institution’s official seal or stamp (such as corporate seal, signature guaranteed stamp, or medallion stamp). Certification by a notary public is NOT acceptable.

I CERTIFY that

, whose identity is known or was

(Name of Person Who Appeared)

proven to me, personally appeared before me this

day of

,

,

(Month)

(Year)

at

, and signed this form.

(City) (State)

(OFFICIAL STAMP OR SEAL)

(Signature of Certifying Officer)

(Printed Name and Title of Certifying Officer)

(Name of Financial Institution)

(Address)

ACCEPTABLE CERTIFICATIONS: Financial institution's official seal or stamp (such as corporate seal, signature guaranteed stamp, or medallion stamp).

(City, State, and ZIP Code)

(Notary certification is NOT acceptable.)

(Phone Number)

INSTRUCTIONS
No. 1	TREASURYDIRECT® ACCOUNT INFORMATION
Provide the TreasuryDirect Account Number and the Account Name. If you want the new bank information added to other TreasuryDirect accounts registered in the same name or to any minor linked accounts for which you are the custodian, provide the account numbers.

No. 2

ADD (EDIT) BANK INFORMATION

Provide the complete bank information as it should appear. The account must be at a U.S. depository financial institution that will accept debits and credits using the Automated Clearing House method of payment. Bank Name – Show the name of the financial institution. Routing Number – Show your financial institution's ABA identifying number. This is the routing/transit number that identifies the institution. You may need to contact the financial institution to obtain this number. Account Number – Show the account number at your financial institution. Name(s) on Account – Show the name or names as it/they appear on the account at your financial institution. Account Type – Mark the appropriate box to indicate whether the account is "checking" or "savings." Mark the box if the bank added is to be your Primary Bank for purchases and payments. A Primary Bank appears first on the bank information list and in the drop-down boxes throughout TreasuryDirect. Complete the fields at the bottom of the section to add another bank.

No. 3	SIGNATURES AND CERTIFICATIONS
The applicant must appear before and establish identification to the satisfaction of an authorized certifying officer available at a bank, trust company, or credit union and sign the application in the officer's presence. The officer must then complete the certification form provided and imprint the seal or stamp required in certifying requests. For certifications within the United States, the certifying individual must be authorized to bind his/her institution by his/her acts and guarantee signatures to assignments of securities or certify assignments of securities. For a list of authorized certifying individuals and the required evidence of authority, see Title 31 CFR Part 363. Certification by a notary public is NOT acceptable. If you are a parent of a minor TreasuryDirect account owner, your signature certifies that you are requesting the transaction on the minor's behalf and for the minor's benefit.
Additional Evidence – The Commissioner of the Fiscal Service, as designee of the Secretary of the Treasury, reserves the right, in any particular case, to require the submission of additional evidence.
Where To Send – Send the form, as well as any other forms and evidence, to: Treasury Retail Securities Site PO Box 7015 Minneapolis, MN 55480-7015
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. CH. 31 relating to the public debt of the United States. The furnishing of a Social Security Number, if requested, is also required by Section 6109 of the Internal Revenue Code (26 U.S.C. 6109). The purpose of requesting the information is to enable the Bureau of the Fiscal Service and its agents to issue securities, process transactions, make payments, identify owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing the information is voluntary; however, without the information the Fiscal Service may be unable to process transactions. Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and the Privacy Act. This information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation purposes; others entitled to distribution or payment; agents and contractors to administer the public debt; agencies or entities for debt collection or to obtain current addresses for payment; agencies through approved computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; as otherwise authorized by law or regulation.
We estimate it will take you about 02 minutes to complete this form. However, you are not required to provide information requested unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Bureau of the Fiscal Service, Forms Management Officer, Parkersburg, WV 26106‑1328. DO NOT SEND the completed form to the above address; send to the address shown in "Where to Send" in the instructions.

INSTRUCTIONS YOU MAY NEED FOLLOWING THE ADDITION OF A BANK ACCOUNT

--KEEP THIS PAGE FOR FUTURE REFERENCE--

Adding a bank account to your TreasuryDirect account is only that—the addition of a bank account. It does not delete any previously entered bank accounts nor does it change the source of funds for pending purchases or the destination for interest and/or maturity payments. After we add a bank account to your TreasuryDirect account, you may need to do one or more of the following:

• Delete a Bank Account – You can access your TreasuryDirect account and delete any bank as long as it is not the Primary Bank. If you would like us to designate a different bank already listed in your TreasuryDirect account as your Primary Bank, e-mail us by clicking the Contact Us link in your TreasuryDirect account.

• Change the Source of Funds for Pending Purchases – You may change the source of funds on pending purchases by accessing your TreasuryDirect account and deleting the previous bank. The system will then prompt you to choose a bank from a drop-down list. If you do not wish to delete the previous bank, you can change the source of funds by deleting the purchases and re-scheduling them using another bank.

• Change the Payment Destination for Interest & Maturity Payments (Treasury Bills, Notes, Bonds, Floating Rate Notes, and TIPS) – You may change the interest and/or maturity payment destination(s) to a different bank by accessing your TreasuryDirect account and deleting the previous bank. The system will then prompt you to choose a bank from a drop-down list. If you do not wish to delete the previous bank, you can change the payment destination(s) by clicking the Edit Payment Destination button on the Current Holdings Detail page for each security.

HOW A CLOSED BOOK PERIOD CAN AFFECT YOUR REQUEST

Four business days prior to a scheduled interest and/or maturity payment, TreasuryDirect imposes a Closed Book Period that locks applicable marketable securities so we can schedule upcoming payments. This rule applies to interest payments, maturity payments, and reinvestments for bills, notes, bonds, Floating Rate Notes, and TIPS.

TreasuryDirect's Closed Book Period starts at 12:00 midnight Eastern Time on the fourth business day prior to the security's interest payment date and/or final maturity date, and it ends at 12:00 midnight Eastern Time on the interest payment/maturity date.

TreasuryDirect will not allow the following during the Closed Book Period:

• Changes to registration

• Changes to the payment destination

• Changes to View/Transact Rights

• Internal and external transfers

• Changes to reinvestments

If the security is in a Closed Book Period because of maturity of the security, any online transactions scheduled but not processed will be cancelled. If the security is simply paying interest, the scheduled transactions will be processed as soon as the security is out of the Closed Book Period.

FS Form 5512

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