Fillable Printable Direct Deposit Form - West Virginia

Direct Deposit Form - West Virginia

DIRECT DEPOSIT FREQUENTLY ASKED QUESTIONS!

How does direct deposit work and how will I know I have been paid?

There will still be a record with direct deposit. Your bank will provide you with a record of

deposits in your account. Many banks also have phone and/or web based information about

account deposits.

How will direct deposit help me?

With direct deposit you can choose the financial institution that best meets your needs. You

can select the type of account and the institution with ATM locations that is most convenient

for you. If you do not choose direct deposit your cash benefits will be deposited in an EBT

cash account for you and you will use your EBT card to spend your cash benefits.

What happens if there is a problem at my bank or if I change my bank?

Contact the West Virginia State Auditor's Office at 304-558-2251 or 800-500-4079. The

problem will be researched and corrected immediately upon determination of the error. To

change your account information you must submit a new Direct Deposit Form. All change

requests must be received by the WV State Auditor's Office at least six business days before

the date of your payment. Do not close your old account until you have received your cash

benefit in the new account. This will help prevent a delay in the receipt of your cash

benefits.

However, if something happens that your bank account is closed or your benefits can't be

direct deposited, they will be delivered to an EBT card cash account.

How can I start direct deposit of my cash benefits?

Complete the WV Works Direct Deposit Form and mail it along with a voided check to the

WV State Auditor's Office.

How do I stop direct deposit?

Contact the WV State Auditor's Office at 800-500-4079 or 304-558-2251. To prevent a

delay in the receipt of your cash benefits do not close your account until your direct deposit

has been cancelled by the WV State Auditor's Office.

WV Works Direct Deposit Form

First Name:

Social Security #:

Address 2:

Address 1:

Telephone #:

Zip Code:State:City:

ACCOUNT INFORMATION

Bank Name:

Savings - Attach a letter from the bank or a bank statement.

Checking - Attach a voided check.

CancelChangeStart Direct Deposit

Date

Signature

For information regarding your direct deposit setup, please contact the ePayments Division at 800-500-4079. For

information regarding your payment please contact your local DHHR office.

Please return to:

West Virginia State Auditor's Office/ ePayments Division

1900 Kanawha Blvd E, Bldg 1, Rm W-121

Charleston, WV 25305

Fax #: 304-340-5084 www.wvsao.gov

Please list the name & social security number of the person receiving cash benefits. If you are receiving cash benefits

for a minor child, please list the parent's or legal guardian's information.

Last Name:

Please select one:

Pursuant to Section 7 of the Privacy Act of 1974, the disclosure of your Social Security Number is mandatory. Social Security Numbers are necessary to properly

maintain records concerning your direct deposit payments as is required and authorized by the federal government for tax administration purposes. See generally, 42

U.S.C. § 405(c). Failure to provide a Social Security Number will prevent us from processing your direct deposit request.

I hereby authorize the State of West Virginia, hereinafter called STATE, to initiate credit entries as indicated on the form above

for my WV Works Cash Assistance Benefits. I further authorize the State to initiate debit entries as adjustments for credit

entries made in error. This authority is to remain in full force and effect until the STATE has received written notification from

me of its termination in such time and manner as to afford the STATE a reasonable opportunity to act on it. The State will not

be responsible for any loss that may arise solely by reason of error, mistake or fraud regarding information provided on this

form. I agree to comply with any guidelines proposed by the WV Works program regarding electronic transfers as they exist

on the date of my signature on this form or as subsequently adopted, amended or repealed.