ESBD_381869_1730473730204_SOL_EXH_F.4_24R0019195A_971-82_DDA.pdf

This is a Direct Deposit Authorization form from the State of Texas Comptroller of Public Accounts, used by vendors, individual recipients, or state employees to receive payments or modify existing direct deposit information. The form consists of eight sections covering transaction types, payee identification, new account information, existing account information, international payments verification, authorization for setup/changes/cancellation, cancellation by agency, and state agency contact information. It allows for various transaction types including new setups, changes to financial institutions or account numbers, and cancellations.

The form requires detailed information including payee type (state employee or vendor/recipient), identification numbers (SSN, TIN, or EIN), banking information (routing and account numbers), and verification of international payments. Financial institution representatives can optionally provide their information and signature. The form requires authorization from both the payee and state agency representatives, with specific instructions for completion provided on page 2. The document includes privacy notices and contact information for questions, directing state employees to their HR department, vendors to accounts payable staff, and state agencies to Fiscal Management Payment Services at 512-936-8138.