Fillable Printable Direct Deposit Application or Cancellation Form - University of Southern California
Fillable Printable Direct Deposit Application or Cancellation Form - University of Southern California
Direct Deposit Application or Cancellation Form - University of Southern California
UNIVERSITY OF SOUTHERN CALIFORNIA
Direct Deposit Application or Cancellation Form (please print)
Name: Last (Family) First Middle Employee or USC ID number
(or Social Security number if no USC number)
Payroll (Attach voided check for each checking account or deposit slip for each savings account and send completed form to: University Payroll Services, UGB 212, MC 8016)
Institution Name Account Number Type Percentage (whole number only)
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
Cash Pay (may be combined with Direct Deposit above) Account Number ______________________________________________________________ Percentage _______________________________
(leave this field blank if it is for initial setup) (total percentage must equal 100%)
Cancellation
Payroll: Cancel direct deposit of my payroll check, and route my paycheck to my Home Department. (Payroll Services will not mail paycheck to home address)
Disbursement Control: Cancel direct deposit of my Reimbursement or Fellowship stipends, and mail my check to the address below:
_________________________________________________________________________________________________________________________________________
Address City State ZIP Code
Read statement carefully: I hereby authorize the University of Southern California to initiate deposits (credits) and/or corrections to the prior deposits (previous credits) to the financial institutions indicated. The financial institution is authorized
to credit and/or correct the amounts to my accounts. This authority is to remain in full force and effect until either I revoke it by giving at least 15 days prior written notice to the University of Southern California, University Payroll Services or
Disbursement Control, or, upon one full quarter of inactivity or termination of my employment. I understand my first direct deposit application or a change of my existing payroll direct deposit will take a minimum of 3–4 weeks to be in
effect. I will notify Payroll Services to cancel my direct deposit prior to closing of my bank account(s). I also understand that my failure to notify Payroll Services prior to closing my bank account(s) may result in a delay in my receiving funds
from my paycheck(s).
(This form will not be processed without your signature)
FOR OFFICE USE ONLY
Prenote by: __________________ Date: ____________
PS. disp by: __________________ Date: ____________
Processed by: ________________ Date: ____________
Direct deposit is available for PAYCHECKS (issued by Payroll), and
also for REIMBURSEMENTS and FELLOWSHIP STIPENDS (issued by
Disbursement Control). You must indicate below how you want
each type of check deposited. You may have different instructions
for each type of payment.
Payroll Checks:
• Your first direct deposit or any change in existing payroll direct deposit will take a minimum of 3 to 4 weeks to process due to banking
requirements. In the interim, your check or existing payroll direct deposit will continue to be routed as per current instructions.
• Cancellation of direct deposit will be processed upon receipt of a complete and signed form.
Reimbursement and Fellowship Stipends:
• Your check will be routed as per current instructions until direct deposit is prenoted by the banks.
• Cancellations of direct deposit take approximately one week to process. Payment will continue to
be handled as per current instructions in the interim.
FACULTY AND STAFF: Your paychecks are issued by Payroll Services. Reimbursements are issued by Disbursement
Control. If you expect to receive reimbursements, complete both sections of the form.
STUDENTS: All paychecks, including Teaching and Research Assistant “stipends,” are issued by Payroll Services.
Fellowship stipends for domestic graduate students (U.S. Citizens and Resident Aliens) are issued by Disbursement
Control. Complete both sections if you are receiving both types of payments.
You must complete the Cancellation section
before closing any designated direct deposit
account. Failure to do so will result in delays
making funds available to you.
Disbursement Control (Attach voided check for each checking account or deposit slip for each savings account. If submitting information for both Payroll and Disbursement Control, please send completed
form to: University Payroll Services, UGB 212, MC 8016. Otherwise, send to: Disbursement Control, UGB 210, MC 8015 Los Angeles, CA 90089-8015, Fax: 213 740-8799)
Deposit my Reimbursement/Fellowship stipends as follows
Change existing Reimbursement/Fellowship stipends instructions
Use payroll information above or current direct deposit information
previously submitted to Payroll Services
Institution Name Account Number Type Percentage (whole number only)
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
_______________________________________________________ ______________________________________________________
Checking
Saving _______________________________
Cash pay is not available for Disbursement Control payments (total percentage must equal 100%)
Signature __________________________________________________ Date _________________________________ Phone number or e-mail __________________________________ UPS/08-04-2010
Deposit my Payroll/NRA Stipend check as follows Change Existing Payroll/NRA Stipend direct deposit
