ESBD_434431_1752096190383_SOL_EXH_F.5_Direct Deposit Authorization Form (74-176).pdf

This document is a Direct Deposit Authorization form issued by the State of Texas for vendors, individual recipients, or state employees to set up or modify electronic payment arrangements. The standardized form allows payees to establish new direct deposit accounts, change existing account information, or cancel current direct deposit setups across various state agencies. The form requires detailed information including financial institution details, routing numbers, account types (checking or savings), and includes sections for both the payee and the state agency to complete.

The form is designed to facilitate secure electronic payments and includes critical verification steps such as an international payments verification section and explicit authorization for the state agency to electronically deposit payments. It provides contact information for different categories of users (state employees, vendors/recipients, and state agencies) and includes instructions for completing each section. The document also contains a Federal Privacy Act Statement noting that disclosure of information like Social Security numbers is required for administration and identification purposes, with protections in place for the individual's data.