ESBD_443789_1754597899330_SOL_EXH_F.4_Direct Deposit Authorization Form.pdf

This document is a Direct Deposit Authorization form from the State of Texas for vendors, individual recipients, or state employees to set up or modify electronic payment information. The form allows users to establish new direct deposit accounts, change financial institutions, update account numbers, or cancel existing direct deposit arrangements. It requires detailed information including payee identification, financial institution details, routing numbers, account types (checking or savings), and includes sections for both new account setup and existing account changes.

The form includes several key sections with specific instructions, such as verifying international payment destinations, providing authorization for electronic deposits, and capturing necessary contact and identification information. It provides contact guidance for state employees (through their Human Resources department), vendors/recipients (through the paying agency's payable staff), and state agencies (through the Comptroller's Payment Management Services). The document also includes a Federal Privacy Act Statement noting that disclosure of Social Security numbers is required for administration and identification purposes, with protections under federal law.