Fillable Printable Child Support Direct Deposit Authorization Form - Texas

Child Support Direct Deposit Authorization Form - Texas

November 2014 Form 6A002e

TEXAS Child Support Disbursement Unit DIRECT DEPOSIT Authorization Form

DIREC T DEPOS IT

Child support payments you receive from the Texas Child Support Disbursement Unit (TXCSDU) may be sent to you by

direct deposit.

If you want all payments you receive from the TXCSDU to be directly deposited to your financial institution, complete the

Direct Deposit Authorization Form using the following instructions. With the exception of your signature, type or print the

requested information.

If you need help with completing the Direct Deposit Authorization Form, contact the TXCSDU between 8:00 a.m. and 5:00 p.m.,

Monday through Friday, at 1-800-252-8014. You may also request assistance from your financial institution in completing the

form.

Return the form to: TEXAS CHILD SUPPORT DISBURSEMENT UNIT, P. O. BOX 659400, SAN ANTONIO, TX 78265

Keep these instructions and a copy of the completed form for your records.

If you do not provide all the information requested, the TXCSDU may not be able to process your Authorization Form.

FREQU ENTLY ASKED QUESTIONS ABOUT DIRECT DEPOSIT

1. How secure and reliable is direct deposit?

Direct deposit is very safe and reliable. It allows money to be electronically transferred from the TXCSDU to your financial

institution. Direct deposit eliminates the possibility of lost or stolen checks. With direct deposit, there are no mail delays and no

check cashing fees to pay.

2. What do I do i f I want to change financial institutions or stop my direct deposit?

Written requests are required for any change or to stop direct deposit. You must call 1-800-252-8014 for a TXCSDU Authorization

Form. Failure to do so may result in a disruption of service.

3. How do I sign up for direct deposit?

To sign up for direct deposit, complete the attached Direct Deposit Authorization Form. Instructions are at the top of this form to

assist you in completing this form. Make sure you include the financial institution routing number, account number, account type and

a voided check or letter from your financial institution with your form.

4. How long does it take to set up direct deposit?

Once the TXCSDU receives your Authorization Form for direct deposit, please allow thirty (30) days for the conversion from check

to direct deposit.

5. How will I know when my payments are being paid by direct deposit instead of by check?

Using your CIN # you can verify whether the TXCSDU has sent a payment to your financial institution via direct deposit. You can

call the Payment Information Line at 1-800-252-8014. In most cases, funds will be available in your bank account two to three

business days after the payment is received at the TXCSDU.

6. Will I be notified when money is deposited in my account?

The TXCSDU will not send you a notice each time a payment is deposited to your account. You can verify that a payment was

deposited to your account by calling 1-800-252-8014 and/or your financial institution automated system.

November 2014 Form 6A002e

TEXAS CHILD SUPPORT DIRECT DEPOSIT

Authorization Form

Please attach a Voided Check or Letter from Financial Institution and Sign the bottom of this form prior to Mailing Back to:

TXCSDU, P.O. Box 659400, San Antonio, TX 78265

Please P rint or Type

1. Direct Deposit Action Requested: (Chec k One)

Attac h V oided Chec k or D e posit Slip Here

Start Change Stop

For accuracy please verify information with your financial institution for

ite ms 2-5

2. Account Type: (Check One)

Checking

Savings

3. Account Number:

4. Transit Routing Number: (9 Digits)

Please co ntact your financial insti tution for this numbe r

5. Name of Financial Institution:

Mailing Address:

Telephone:

6. Name of Payee: (last, first, mid dle) Custodial Parent

7. Name of Payor: (last, first, middle ) Non-Custodial Pa r e nt

8. County assigned Cause Number (see Court order):

9. Payee Address: (Number and Stre e t) City, State and Zip Code

10. Payee Telephone Numbers:

Work:

Home:

11. Payee Social Security Number: (Custodial Parent)

12. Signature: (Custodial P a r e nt)

Date:

Signature above signifies agreement with terms and conditions below.

By signing this authorization form, I consent to the policy of the Office of the Attorney General (OAG) for recovering money sent to me in error. Money

sent to me in error, NOT repaid within 30 days of notice of overpayment, will be withheld from future child support payments.

I authorize the financial institution to accept the deposit for my account and to make adjustments to my account to correct any error relating to

the

deposit.

I agree and understand that this authorization for direct deposit revokes OAG form 1A004, Authorization for Release of Information with

respect to redirection

child support payments.

This authorization form will remain in effect until revoked by me in writing or canceled by the financial institution and supersedes any

existing

instructions

concerning

my child support direct deposit. I also understand that I have a

responsibility

to provide a written request to

discontinue

the deposit. To discontinue direct deposit and provide a mailing address for future payments I must call 1-800-252-8014 to request

an authorization form. The authorization form should

returned to the TXCSDU, P. O. Box 659400, San Antonio, TX

78265.

I agree that the TXCSDU will have no

responsibility

for personal checks written against my account prior to the funds being available in my

account, and my account will be administered in accordance with the rules and regulations of the financial

institution.

WARNING: This is a governmental document. Texas Penal Code, Section 37.10 specifies penalties for making false entries or providing false

information in

the document.