ESBD_393686_1738337626949_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 of Public Accounts, 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. 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.

The form requires detailed banking information including routing numbers and account numbers, with options for both checking and savings accounts. It includes verification requirements for international payments and requires authorization signatures from both the payee and state agency representatives. The form is accompanied by comprehensive instructions and contact information for state employees, vendors/recipients, and state agencies, with specific guidance for completing each section. The document references compliance with Chapters 552 and 559 of the Government Code regarding information rights and privacy protections.