How to Apply for the Direct Express

The Direct Express® Debit MasterCard® is issued by Comerica Bank,
Bank
pursuant to a license by MasterCard International
nternational Incorporated.
MasterCard® and MasterCard® Brand Mark are registered trade
marks of MasterCard International Incorporated.
A
Great news for those receiving VA Compensation or
Pensi on, RRB Annui ty and OPM (Federal Retirement)
benefits! One quick call to us at 1-800-333-1795 is all
you need to do to begin to receive your payments on
the Direct Express® card. No paper form is required!
Calls us today to enroll.
Direct Express®
Express and the Dir ect Express® logo are service
marks of the U.S. Department of the Treasury, Financial
Management Services (used with permission).
How to Apply for the Direct Express® Card
You are receiving this Application for the Direct Express® Debit MasterCard® Card because:
•
You asked us to send you information, and/or
•
We were unable to process your Application when you tried to sign up for the Direct Express®
Card.. Please complete the enclosed Application so that we may confirm your personal
information.
HOW DO I COMPLETE THE APPLICATION?
If you are a Benefit Recipient (a person who is entitled to F
Federal benefits):
•
Complete Sections 1 and 4 on the enclosed Application
•
Mail the completed and signed Application, along with the documents described in Section 3 of
the Application, to the address below.
If you are a Representative Payee (a person who receives payments for one or more Benefit Recipients):
•
Complete Sections 1, 2, and 4 on the enclosed Application. If you are the Representative Payee
for more than one Benefit Recipient, please complete a separate Application for each recipient.
•
Mail the completed and signed Application, along with the documents described in Section 3 of
the Application, to the address below.
Mail your completed and signed application, along with copies of the required documents, to:
Direct Express®
PO Box 7050
London, KY 40742
What Happens Next?
Once we receive your documents, your Application for the Direct Express® debit card will be processed.
If we are able to verify your personal information and the federal agency confirms your payment
information, you should receive your Direct Express® debit card in 7 to 14 days. Your payments will then
be automatically deposited to your new debit card account on the same day you currently receive your
regular paper check. You may receive one more paper check before yo
your
ur payments are switched to your
new Direct Express® debit card. If your information is not complete or we still are not able to verify
your personal information or benefit eligibility, a Direct Express® Customer Service Representative will
contact you.
D ire ct Express®
Express and t he D ir ect Expre ss® logo are service marks of the
U.S . De partment of the Treasury, Financial Manage me nt Se rvices
(used with permission).
APPLICATION FOR DIRECT EXPRESS® DEBIT MASTERCARD® CARD
Section 1. Benefit Recipient Information (about the person who is entitled to Federal benefits)
Payment Type:
SSA Benefits
SSI Benefits
Name: ________________________________________________ Date of Birth: ________/________/_________
Social Security Number: _______-_____
___-__________
__________ Daytime Phone: (
) __________________________
Current Mailing Address: _______________________________________________________________________
City: ___________________________________ State: ___________________ Zip Code: ___________________
Section 2. Representative Payee Information (about the person who receives payments for one or more Benefit
Recipients) If you are a Representative Payee for more than one Benefit Recipient, please submit a separate
Application for each Benefit Recipient.
Name: ________________________________________________ Date of Birth: ________/________/_________
________/___
Social Security Number: _______-_______
___-__________
__________ Daytime Phone: (
) __________________________
Current Mailing Address: _______________________________________________________________________
City: _______________________________
___________________________________
____ State: ___________________ Zip Code: ___________________
Section 3. Verification of Personal Information
Information. To verify your personal information, please enclose copies (no
originals, please) of each of the following:
Valid,, government issued, photo identification. For example: driver’s license, state issued photo identity
card, or passport. A Representative
epresentative Payee
ayee should submit their own identification, not the beneficiary’s
identification. If your address
ress has recently changed, please send us identification with the correct address;
and
Recent Social Security benefit check (Do not send original check) or your last SSA-1099.
SSA
The check
should not be more than 31 days old; the SSA
SSA-1099 should not be more
re than 1 year old, and
Utility bill that is less than 60 days old and is addressed to you at your current address. For example:
electric bill, gas bill, phone bill, water bill, or cable bill. A Representative Payee should submit their own utility
bill, not the beneficiary’s bill.
Section 4.. Authorization and Affirmation:
®
I authorize the Federal Agency that pays my benefits to credit all of my payments to my Direct Express debit card
®
account. I understand that the Direct Express card will be mailed to me once my personal information and eligibility
to receive benefits have been confirmed. To the best of my knowledge, the information contained in this Application
is true, accurate, and complete.
__________________________ Date:: _________________________
Signature: ________________________________________________
Mail your completed and signed application, along with copies of the required documents, to:
Direct Express®
PO Box 7050
London, KY 40742
The Direct Express® Debit MasterCard® is issued by Comerica Bank, pursuant to a license by MasterCard International Incorporated.
MasterCard® and MasterCard® Brand Mark are registered trade marks of MasterCard International Incorporated.