ESBD_466583_1762197788393_SOL_EXH_F.9_Direct Deposit Authorization Form.pdf

This document is the State of Texas Direct Deposit Authorization Form (74-176), which serves as the administrative instrument for state employees, vendors, and recipients to establish or modify direct deposit arrangements with the State Comptroller's office for payment receipt. The form facilitates multiple transaction types including new account setup, changes to financial institution or account information, account type modifications, and cancellation of direct deposit services. There are no specific products or services being procured through this form, nor are there project timelines, response dates, bidder conferences, or contract award terms associated with it, as this is an operational administrative form rather than a procurement document. The form is designed for use by any entity receiving payments from the State of Texas and can be submitted at any time as needed to establish or modify direct deposit preferences.

The form requires payee identification including Social Security Number or Individual Taxpayer Identification Number, and completion by the financial institution is recommended to ensure accuracy of banking information. New account information sections require the routing number, customer account number (maximum 17 characters), account type designation (checking or savings), and optional contact information for the financial representative. For international payments, payees must confirm whether payments will be forwarded outside the United States and complete the ACH Payment Destination Confirmation Form (74-227) if applicable. Authorization requires an original signature from the payee, and state agencies must also authorize changes through a designated representative. The form includes sections for agency contact information, cancellation documentation, and instructions referencing Texas Government Code Chapters 552 and 559, which grant payees rights to review, request correction, and challenge information maintained on file.