ESBD_384427_1733781044485_F.5 Direct Deposit Authorization Form (74-176).pdf

This is a Direct Deposit Authorization Form (Form 74-176) from the State of Texas Comptroller's office. The form is used by vendors, individual recipients, or state employees to receive payments from the state of Texas via direct deposit or to modify existing direct deposit information. It contains sections for transaction types (new setup, changes to accounts, cancellations), payee identification, new account information, existing account information, international payments verification, and authorization requirements.

The form requires specific information including the payee's identification (SSN, TIN, or EIN), financial institution details, routing numbers, and account numbers. It includes verification for international payments and requires authorized signatures from both the payee and state agency representatives. The form must be returned to the paying agency at a specified address, and questions can be directed to the appropriate department based on whether the payee is a state employee, vendor/recipient, or state agency. For state employees, they should contact their HR department; vendors/recipients should contact the paying agency's accounts payable staff; and state agencies should contact Fiscal Management, Payment Services at 512-936-8138.