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1249 South Vinnell Way, Suite 108

Boise, ID 83709

1-877-471-2262

Fax: 208-947-3799

casual_pay@blm.gov

**ADDRESS CHANGE FORM**

**Directions:**

Complete this form to change a current mailing address. The form must be
[signed]{.underline} and sent to the Casual Payment Center.

**Check One: BIA** **BLM** **FWS**

  ----------- ---------------------------- ----------- ------- --------------------
  **Name:**                                **SSN:**            

                                           **Phone             
                                           number:**           
  ----------- ---------------------------- ----------- ------- --------------------

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

Please do not indicate a street address that does not receive delivery
from the post office. If indicated a PO Box, ensure that your name is
the registered owner of the box, or checks will not be delivered.

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

***Indicate where you would like your check sent:***

  ------------------------- -------------------------------- ------------ ------------------------ --
  **[Check Mailing                                                                                 
  Address:]{.underline}**                                                                          

                            **City                           **State      **Zip                    
                            \_\_\_\_\_\_\_\_\_\_\_\_\_\_**   \_\_\_\_**   \_\_\_\_\_\_\_\_\_\_**   
  ------------------------- -------------------------------- ------------ ------------------------ --

\*\* This is where your treasury checks will be mailed to if you do NOT
want a direct deposit.

**Please *keep* my direct deposit account**

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

  ------------------------- -------------------------------- ------------ ------------------------
  **[Correspondence                                                       
  Address:]{.underline}**                                                 

  \*If different than above                                               

                            **City                           **State      **Zip
                            \_\_\_\_\_\_\_\_\_\_\_\_\_\_**   \_\_\_\_**   \_\_\_\_\_\_\_\_\_\_**
  ------------------------- -------------------------------- ------------ ------------------------

\*\* This is where Wage and Earnings Statements, W-2s and other
correspondence will be sent.

**\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\***

*I verify that the above information is true and correct*

**Signature:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**Date**: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If you have any questions, please call the Casual Payment Center at
1-877-471-2262.