Laserfiche WebLink
<br />=:-rm :~.15a ,2-i:>o:~IP.;h o:i.;l5."!l' <br /> <br />iNSTRUCTIONS FOR <br />DIRECT DEPOSIT AUTHORIZATION <br /> <br />SECTION 1: Check the appropriate box(es) <br />o NEW SETUP - If payee IS not currently on direct deposit with the state. <br />a. Complete Sections 2. 3 & 4. <br />b. Financial institution representative must complete Section 4. <br />o CANCELLATION - If payee wishes 10 StOp direct depOSit with the state. <br />a. Payee completes Sections 2 & 3. <br />o INTERAGENCY TRANSFER - For Slate employees only who transfer from one state agency to another. <br />a. Employee completes Sections 2 & 3. <br />b. Employee should submit form to the new paying state agency for completion of Section 7. <br />o EXEMPTION - If payee claims an exemption granted by Tex. Gov!. Code Ann. 9403.016. <br />a. Payee completes Sections 2 & 5. <br />o CHANGE FINANCIAL INSTITUTION <br />a. Payee completes Sections 2 & 3. <br />b. The new financial institution rep'esentative completes Section 4. <br />o CHANGE ACCOUNT NUMBER <br />a. Payee completes Sections 2 & 3. <br />b. Financial institution representative completes Section 4. <br />. CHANGE ACCOUNT TYPE <br />a. Payee completes Sections 2 & 3. <br />b. Financial institution representative completes Section 4. <br /> <br />.' <br /> <br />SECTION 2: PAYEE IDENTIFICATION <br />Item 1 Leave the shaded boxes blank If you 00 not have your 11-digit Comptroller Payee Identification number. The <br />paying Slate agency Will provloe the information to be entered in the shaded boxes. Enter your 9.digit Social <br />Security number or your Federal Employer's Identification (FEI) number. <br />Item 2 If your 3-diglt mail code is nol known. ,t will be assigned by the paying state agency. <br /> <br />SECTION 3: AUTHORIZATION FOR SETUP. CHANGES OR CANCELLATION <br />Items 10. 11 The individual authOrizing must sign. Orlnt their name ana date the form. <br />& 12 <br /> <br />NOTE: No alterations to this section Will be allowed. <br /> <br />~ECTION 4: FINANCIAL INSTITUTION <br />Section 4 must be completed by a financial institution representative. <br />Item 19 Tile financial institution representative S name must be proVided in Section 4. <br />NOTE: Alterations to routing anaior account number must be initialed by the financial inslitution representative <br />or the payee. <br /> <br />SECTION 5: EXEMPTION (Not to be completed for vendors or employee travel payments) <br />a. If you qualify far an exemption. check the appropriate box. <br />b. Complete items 27. 28 and 29. <br />NOTE: Exemption forms are malntalnea by the paying state agency. <br /> <br />SECTION 6: CANCELLATION BY AGENCY <br />Sections 5 & 7 must be completed by the paying state agency. <br /> <br />SECTION 7: PAYING STATE AGENCY <br />Section 7 must be completed by the paying state agency before the form can be processed. <br /> <br />Submit the Comotrolfer COpy and Agency COoy to your paying state agency. Retain the Payee Coov for your records. <br />