Personal Interview - Intranet Screens (field office or National 800 Number)

Domestic Direct Deposit Application

A101 System

Personal Interview - Intranet Screens (field office or National 800 Number)

OMB: 0960-0634

Document [doc]
Download: doc | pdf

Automated 101 System: Screen Package

Table of Contents




A101

ACCOUNT DATA


LnNo

0

1

1 2 3 4 5 6 7 7

234567890123456789012345678901234567890123456789012345678901234567890123456789

8

0

1

C

A101 ACCOUNT DATA ACCT SA0

1

2

0

NH SSN: SSS SS SSSS


3

l



4

u

*NH FIRST NAME: XXXXXXXXXXXXXXX MIDDLE: XXXXXXXXXXXXXXX


5

m

LAST: XXXXXXXXXXXXXXXXXXXX SUFFIX: XXXX *RACE: X *NH SEX: X


6

n



7

*

*TYPE OF ACTION CODE: X *NH DATE OF BIRTH (MMDDCCYY): 99999999


8

o

DATE OF DEATH (MMDDCCYY): 99999999 PROOF OF DEATH: X


9

n

*ANNUITY INVOLVED (Y/N): X


10

e

MILITARY SERVICE CODE: XXX WC/PDB OFFSET DATA ON ICF (Y/N): X


11


RAILROAD CODE: XXX *CRITICAL CASE (Y/N): X


12

r

COMPASSIONATE ALLOWANCE/QUICK DISABILITY DETERMINATION (Y/N): X


13

e

DISABILITY FREEZE CODE (Y): X ADJUSTED BLIND ONSET (MMDDCCYY): 99999999


14

s

CHILD CARE DROPOUT YEARS: X


15

e

BASE YEAR (CCYY): 9999 THRU (CCYY): 9999


16

r

DIVIDEND: 99999999.99 DIVISOR MONTHS: 999


17

v



18

e

TOTALIZATION COUNTRY CODE: XXXXX STATUS CODE: XX QC’S: 999


19

d



20


LSDP PAYABLE BIC 1: XXX AMT 1: 999.99 BIC 2: XXX AMT 2: 999.99


21


BIC 3: XXX AMT 3: 999.99 BIC 4: XXX AMT 4: 999.99


22




23


**************(line 23 reserved for applications information)*****************


24


**************(Line 24 Reserved for Operating Systems Information)***********



SCREEN FR MSO







A101

BENEFICIARY DATA


LnNo

0

1

1 2 3 4 5 6 7 7

234567890123456789012345678901234567890123456789012345678901234567890123456789

8

0

1

C

A101 BENEFICIARY DATA BENE SA0

2

2

0

NH SSN: SSS SS SSSS NH NAME: SSSSSSSSSS S SSSSSSSSSSSSSSSSSSSS SSSS


3

l



4

u

BN SSN: SSSSSSSSS *BIC: XXX BN PIA POINTER: 9


5

m

DELAYED CLAIMANT (Y): X COMBINED FAMILY MAXIMUM (Y): X


6

n

*BN FIRST NAME: XXXXXXXXXXXXXXX MIDDLE: XXXXXXXXXXXXXXX


7

*

LAST: XXXXXXXXXXXXXXXXXXXX SUFFIX: XXXX *SEX: X


8

o

*DATE OF BIRTH (MMDDCCYY): 99999999 *PROOF OF BIRTH: X


9

n



10

e

RIB LIMITATION APPLIES (Y): X RAILROAD CERTIFICATION (Y): X


11


IF WIDOW, PAID CHILD IN CARE BENEFITS FOR AT LEAST 1 MONTH (Y): X


12

r



13

e

CROSS REFERENCE SSN: 999999999 STATUS CODE: XX CIVIL SERVICE ID: XXXXXXXXXX


14

s

NH’S DRC: 99 THRU (MMYY): 9999 *CRIMES AGAINST U.S. INDICATOR (Y/N): X


15

e



16

r

*LEGEND 1: XXXXXXXXXXXXXXXXXXXXXX LEGEND 2: XXXXXXXXXXXXXXXXXXXXXX


17

v

LEGEND 3: XXXXXXXXXXXXXXXXXXXXXX LEGEND 4: XXXXXXXXXXXXXXXXXXXXXX


18

e

*BANK ACCOUNT (Y/N): X *DIRECT EXPRESS (Y/N): X


19

d

RTN: 99999999 CDC: 9 DPC (C/S): X DAN: XXXXXXXXXXXXXXXXX


20




21


REP PAYEE TYPE: XXX GUARDIAN STATUS CODE: X CUSTODY CODE: XXX


22


NEGOTIATED ACCOUNTABILITY MONTH (MMYY): 9999


23


**************(line 23 reserved for applications information)*****************


24


**************(Line 24 Reserved for Operating Systems Information)***********



SCREEN FR MSOM




The A101 beneficiary data screen propagates to the MACADE screens. This screen collects/displays data for each beneficiary such as the social security number BIC, name, sex, date of birth and bank account information. The following specifically describes fields related to direct deposit bank account, direct express, routing transaction numbers, deposit account number, check digit code, and deposit payment code.



File Typeapplication/msword
Author889123
Last Modified By297862
File Modified2012-07-17
File Created2012-07-17

© 2024 OMB.report | Privacy Policy