ESBD_466685_1762200836290_SOL_EXH_F.5_Direct Deposit Authorization Form.pdf

This document is a Direct Deposit Authorization form (Form 74-176) issued by the State of Texas for use by vendors, individual recipients, and state employees to establish, modify, or cancel direct deposit payment arrangements with the state.

The form enables users to select from six transaction types: new account setup, changes to financial institution, account number modifications, account type changes, and cancellation of direct deposit services. The payee identification section requires specification of whether the recipient is a state employee or vendor, along with identification information such as Social Security number, Texas Identification Number, or Employer Identification Number. The form requests new account information including the financial institution name, routing number, customer account number, and account type (checking or savings). For existing accounts, users must provide current routing and account numbers. The form includes a required international payments verification section asking whether payments will be forwarded to institutions outside the United States; if so, completion of the ACH Payment Destination Confirmation form is required. Authorization for setup, changes, or cancellation requires the payee's original signature, printed name, and date. State agency personnel must also complete sections for agency authorization, phone contact information, agency number, and agency name, with the completed form returned to the designated paying agency.

The form contains no pricing information, set-asides, incumbent references, or funding amounts, as it functions solely as an administrative authorization document for managing direct deposit arrangements with the State of Texas. Completion of the financial institution information section by the financial institution itself is recommended but not required.