Fillable Printable Form RI 38-128
Fillable Printable Form RI 38-128
Form RI 38-128
U.S. Office of Personnel Management
Form Approved
OMB No.: 3206-0226
Retirement Services and Management
Post Office Box 440
Boyers, PA 16017-0440
Date:
It's Time to Sign Up for Direct Deposit or Direct Express
The United States Department of the Treasury will pay all federal benefits electronically by Direct Deposit or by Direct
Express.
You can be paid by Direct Deposit into your account in a bank, credit union, savings bank, or thrift institution. Many
financial institutions offer basic, low-cost accounts, as well as full-service accounts. Direct Deposit is safe, reliable, and
convenient for you. You do not have to take care of a paper check (which could be delayed in the mail, lost, or stolen).
For more information about Direct Deposit, call us on 1-888-767-6738 (TTY: 1-855-887-4957) Monday through Friday
from 7:30 AM to 7:45 PM Eastern time. It is easy to sign up. You can call us toll-free using the numbers shown above.
If you do not want to call us to enroll, you can fill this form out and FAX it to 724-794-6633. Or, you can mail this form
to our Boyers, Pennsylvania, address shown at the top of this page.
If you are not enrolled in the Direct Deposit program, you will need to arrange for a Direct Express debit card provided
by the Department of the Treasury. To obtain a debit card, go to www.godirect.org. You will also find complete
information about Direct Express on this website. Your payments will be electronically placed on the Direct Express
debit card. You can use this card like cash to make purchases; you can obtain cash from bank or credit union tellers or
from ATM machines.
If you are not enrolled in the Direct Deposit program or in Direct Express, you must contact the Department of the
Treasury at 1-800-333-1795 to discuss your options for receiving payment. If you do not take action, the Department of
the Treasury will contact you.
Retirement Operations
Enclosure: Return Envelope
Public Burden Statement
We estimate this form takes an average of 30 minutes to complete, including the time for reviewing instructions, getting the needed data, and reviewing
the completed form. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time, to
the Office of Personnel Management, Retirement Services Publications Team (3206-0226), Washington, DC 20415-3430. The OMB Number
3206-0226 is valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.
RI 38-128
Previous edition is usable. Revised June 2013
Applicant's name
Claim number
Direct Deposit Information
To have your annuity payments made by Direct Deposit, please complete Section A. You may also receive Direct
Deposit by calling us or by completing a Standard Form 1199A (available at most financial institutions). If you want
payments by Direct Express, please complete Section B.
Section A - Payment by Direct Deposit
I want to receive my annuity payments by Direct Deposit into the account indicated below.
Your daytime telephone
number
Your Email address
( )
Account Information - Please contact your financial institution to obtain accurate and complete account and routing
numbers. If you prefer, you may attach a voided check instead of entering the account and routing numbers.
However, we cannot accept a deposit slip for this purpose.
Account type Account number
Checking
Savings
Financial institution routing
Name, address and telephone number of your financial institution
Your signature* Date
( )
Section B - Payment by Direct Express
Please pay me by Direct Express debit card.
Your signature* Your daytime telephone
number
Date
( )
Your Email address
*You must sign. We cannot accept the signature of a person holding your power of attorney. We can accept the
signature of an OPM-approved representative payee or a court-appointed fiduciary, if we have a copy of the court
appointment.
Reverse of RI 38-128
Revised June 2013
PRINT
SAVE
CLEAR
