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OMB No. 15100007 TEST Standard Form 1199A (March 2005) Prescribed by Treasury Department Cir. 1076 DIRECTIONS Please refer to the information on the reverse side before completing this form. You must
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This form is a proposed revision for the USMTM.
All parties involved in the USMTM agreement are required to file this form.
The form must be filled out accurately with all required information regarding the proposed revisions to the USMTM agreement.
The purpose of this form is to document and communicate any proposed revisions to the USMTM agreement.
The form must include details of the proposed revisions, reasons for the changes, and any supporting documentation.
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1943 2005 TDD APO 9-DIGIT recordkeeper USMTM Cir ineligibility OMB 1199A FPO Hyattsville disbursing TTY respondent authorizes incapacity applicable recipients retention CERTIFICATION ALLOTMENT AE certify Listings supplemental ROUTING MD disclosed pertaini

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