Fillable Printable Retired Allotment Authorization Form
Fillable Printable Retired Allotment Authorization Form
Retired Allotment Authorization Form
U.S. DEPARTMENT OF
HOMELAND SECURITY
U. S. Coast Guard
CG-7221 (Rev. 07-10)
RETIRED ALLOTMENT AUTHORIZATION FORM
Employee ID
Name (Last, First, MI) Rank/Rate
PURPOSE: Use this form to start, stop, or change an allotment and to report a change of address to an allotment
Purpose of request:
First Allotment
Start
Allotment
Stop
Allotment
Change
Allotment
Change of
Allotment
Address
(Applies to Stops & Changes)
Blanket Code (If known): Stop Amount:
Enter allotment title/name from pay slip:
Start Amount: Month of Last Deduction:
Month of First Deduction:
For payment dated:
ALLOTMENT TYPE Enter type of allotment (B, D, H, I, L, M, N, O, S, T, or X) from table on reverse of this form:
ELECTRONIC FUNDS TRANSFER (EFT) INFORMATION Complete if allotment is to be paid by EFT
Type of Account
Savings
Checking
Allotee Name:
(person/company who will
receive allotment)
Routing Transit Number (RTN)
(can be obtained from the financial institution or found on the bottom of a check or deposit slip)
Account Number
Account Title
Financial
(Account Holder’s Name)
Institution Name
Purpose of request:
Second Allotment
Start
Allotment
Stop
Allotment
Change
Allotment
Change of
Allotment
Address
(Applies to Stops & Changes)
Blanket Code (If known): Stop Amount:
Enter allotment title/name from pay slip:
Start Amount: Month of Last Deduction:
Month of First Deduction:
For payment dated:
ALLOTMENT TYPE Enter type of allotment (B, D, H, I, L, M, N, O, S, T, or X) from table on reverse of this form:
ELECTRONIC FUNDS TRANSFER (EFT) INFORMATION Complete if allotment is to be paid by EFT
Type of Account
Savings
Checking
Allotee Name:
(person/company who
will receive allotment)
Routing Transit Number (RTN)
(can be obtained from the financial institution or found on the bottom of a check or deposit slip)
Account Number
Account Title
Financial
(Account Holder’s Name)
Institution Name
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-7221 (Rev. 07-10) Continued on Reverse
Reverse of CG-7221 (Rev. 07-10)
Table of Rules
Code
Limit
Type
Use
B
1
TreasuryDirect
Payable to a TreasuryDirect account you have established at
www.treasurydirect.gov, for purchasing Treasury bonds/securities. In the
ELECTRONIC FUNDS TRANSFER blocks above, show:
*Type of Account: Savings
* Allotee Name: TREASURYDIRECT
* Routing Transit Number (RTN): 051736158
*Account Number: Your TreasuryDirect account number (without hyphens)
*Account Title: Name on your TreasuryDirect account
*Financial Institution Name: Bureau of Public Debt
S
Two
Savings
Payable to any financial institution, other than a finance company, provided the
institution is capable of receiving payment through Electronic Fund Transfer
(EFT).
H
One
Mortgage
Payable for loans for the purchase of a home, mobile home or trailer used as a
residence by the retiree.
N
One
NSLI
National Service Life Insurance premiums.
L
No
Limit
Loan
Payable ONLY to Coast Guard Mutual Assistance or morale fund offices and the
allotment MUST have a stop date.
T
No
Limit
Indebtedness
Payable to IRS or other Government agency and MUST have a stop date.
D
No
Limit
Dependent
Support of dependents, including a former spouse.
I
No
Limit
Insurance
Payable to any insurance company for payments of insurance premiums for the life
of the retiree or retiree and family.
I
One
VGLI
Payable to the Office of Servicemember’s Group Life Insurance (OSGLI) for
Veterans Group Life Insurance. This allotment cannot be started through PPC--it
must be started through OSGLI, Newark, NJ, 1-800-419-1473
M
One
Insurance
Payable to the Navy Mutual Aid Association.
O
One
AAFES
Army Air Force Exchange Service DPP Program
X
No
Limit
Dues
Payable to CPOA, CWOA, Academy Alumni Association, Coast Guard
Foundation, Naval Aviation Museum Foundation, and CGHQ Mutual Assistance
Campaign.
Privacy Act Statement
In accordance with 5 USC section 552a(e)(3), the following information is provided to you when supplying personal information to the U.S. Coast
Guard:
AUTHORITY: 37 U.S.C. 101 et seq; E.O. 9397, November 1943 (SSN).
PRINCIPAL PURPOSES: To permit starts, changes, or stops to allotments. To maintain a record of allotments and ensure starts, changes, and stops
are in keeping with member's desires.
ROUTINE USES: Information may be disclosed to Congress; allottees; Secret Service; General Accounting Office; Federal, State, and local courts;
U.S. Treasury; and to the Department of Justice in some cases for criminal prosecution, civil litigation, or investigative purposes.
DISCLOSURE: Voluntary; however, failure to provide the requested information as well as the SSN may result in the member not being able to start,
change, or stop allotments. The furnishing of SSNs is required by the regulations governing Department of Treasury Circular, Public Debt Series No. 3-
80 (31 CFR 353). Other information requested by this form is also required under the above regulations to establish the rights, authority and/or
entitlement of the signers. Failure to furnish any of the required information may prevent completion of the transaction.
FAX to PPC (RAS) at (785) 339-
3770
You can also mail to:
Commanding Officer (RAS)
U. S. Coast Guard Pay & Personnel
Center
444 S E Quincy St.
Topeka, KS 66683-3591
Your Signature
Date:
Your E-Mail Address (optional):
For PPC Use Only
Action Completed:
Date: _________________
Initials: _________________
