Instructions for Completing the 1199A Direct Deposit Form
To access Federal grant funds, all AFI grantees must set up direct deposits by filling out the Standard Form 1199A.
AFI grantees should follow the special instructions below when filling out the 1199A. Do not use the instructions provided on the form itself.
If it helps, review this sample of a completed 1199A form.
Download the Standard Form 1199A and complete it according to the special guidelines below. Review your completed form to ensure all the information is correct. The final form should have no corrections, marks, whiteouts, or other changes.
After completing the 1199A, download and complete the Division of Payment Management (DPM) PMS/FFR User form.
"All AFI grantees need to submit a 1199A form to set up their direct deposit and receive their Federal award funds"
Then submit the Standard Form 1199A, with original signatures, and the completed DPM Primary Contact Person form to DPM. Send copies of both forms to the Office of Grants Management (OGM) and Office of Community Services (OCS)and keep copies for your records.
Special AFI Guidance for Completing the Direct Deposit Form (Standard Form 1199A)
Box A – Enter the grantee organization name, address, and telephone number. This information must be as it appears in the approved grant application and Box 11 of the Notice of Award (NoA) document. Please contact OGM before submitting the form if any of this information has changed.
Box B – Enter the name of the grantee organization (never put an individual's name) as it is shown on the approved grant application and Box 11 of the NoA. Please contact OGM if any of this information has changed.
Box C – Enter the grantee organization's employer identification number as it appears in Box 22 on the NoA. (Note that the NoA includes a prefix and suffix.)
Box D – Enter the type of depositor account (checking or savings).
Box E – Enter the account number for the Project Reserve Fund specific to this award.
Box F – For the type of payment, check "Other" and enter "Grant award/nonprofit/AFI" in the space provided.
Box G – Leave blank.
The authorized official is named in the grant application and Box 11 of the NoA, unless he or she has changed.
"JOINT ACCOUNT HOLDERS' CERTIFICATION" – Leave blank.
"Government Agency Name" – Enter "Division of Payment Management."
"Government Agency Address" – Enter "PO Box 6021, Rockville, MD 20852."