Ohio Direct Deposit Form 1

State of Ohio
Dept. of Administrative Services
Employee Name
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
Last
First
Middle Initial
Social Security Number
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION
1
SAVINGS ACCOUNT
OR
2
CHECKING ACCOUNT
City
State
ACCOUNT
NUMBER
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
Employee Signature
ADM 4280 (REV. 4/2000)
Agency
State of Ohio
Dept. of Administrative Services
Transit Routing No.
Date
Payroll
Number
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
Employee Name
First
Last
Middle Initial
Social Security Number
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION
1
SAVINGS ACCOUNT
OR
2
CHECKING ACCOUNT
City
State
ACCOUNT
NUMBER
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
Employee Signature
ADM 4280 (REV. 4/2000)
Agency
State of Ohio
Dept. of Administrative Services
Transit Routing No.
Date
Payroll
Number
AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
Employee Name
Last
First
Middle Initial
Social Security Number
I AUTHORIZE THE STATE OF OHIO TO DEPOSIT MY PAYROLL CHECK INTO MY ACCOUNT IN THE FINANCIAL INSTITUTION NAMED BELOW BY AUTOMATIC TRANSFER.
THIS AUTHORIZATION WILL REMAIN IN EFFECT UNTIL I SUBMIT A NEW FORM OR FORMS (SEE REVERSE SIDE).
NAME OF FINANCIAL INSTITUTION
1
SAVINGS ACCOUNT
OR
2
CHECKING ACCOUNT
City
State
Transit Routing No.
ACCOUNT
NUMBER
USE FORM ADM-4286 TO
DISCONTINUE DIRECT DEPOSIT
Employee Signature
ADM 4280 (REV. 4/2000)
Agency
Date
Payroll
Number
INSTRUCTIONS FOR AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
1. Enter employee name as it appears on paycheck.
2. Enter the Social Security Number.
3. Enter the name and address of the financial institution (bank,
savings and loan, credit union, etc.) in which you want your
check deposited.
4. Enter your financial institution’s “Transit/ABA Number.” This
is a nine digit number and is shown on your personal check
and/or deposit ticket. Please verify this number at the
financial institution. If you elect to deposit in a savings
account, contact your bank for its Transit/ABA Number.
5. Check the type of account, checking or savings.
6. Enter your personal account number. You can obtain your
account number from your bank statement or your savings
account passbook. Otherwise, contact your financial
institution for your account number.
7. Sign Authorization Form and enter date.
8. Enter the agency where you work.
9. If you elect to deposit in a checking account, please attach a
voided check or a deposit ticket.
10. Forward the signed authorization and attachment to your
payroll officer.
11. For one pay period after the effective date of your authorization,
your earnings statement will indicate the financial institution
and account number where your money will be transferred.
You must verify these numbers and if incorrect, notify your
payroll officer immediately.
Cancellation of Direct Deposit requires Form ADM 4286 to be
completed and forwarded to your payroll officer.
If you change accounts and/or financial institutions, complete
form ADM 4286 for your old account and a new form ADM
4280 for your new account. Forward all materials to your
payroll officer. Remember your new account will go through
one pay period of pre-notification as indicated in item 11.
Therefore, you may not want to cancel your old account before
that time. In addition, this procedure will begin no earlier than
the pay period after receipt.
INSTRUCTIONS FOR AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
1. Enter employee name as it appears on paycheck.
2. Enter the Social Security Number.
3. Enter the name and address of the financial institution (bank,
savings and loan, credit union, etc.) in which you want your
check deposited.
4. Enter your financial institution’s “Transit/ABA Number.” This
is a nine digit number and is shown on your personal check
and/or deposit ticket. Please verify this number at the
financial institution. If you elect to deposit in a savings
account, contact your bank for its Transit/ABA Number.
5. Check the type of account, checking or savings.
6. Enter your personal account number. You can obtain your
account number from your bank statement or your savings
account passbook. Otherwise, contact your financial
institution for your account number.
7. Sign Authorization Form and enter date.
8. Enter the agency where you work.
9. If you elect to deposit in a checking account, please attach a
voided check or a deposit ticket.
10. Forward the signed authorization and attachment to your
payroll officer.
11. For one pay period after the effective date of your authorization,
your earnings statement will indicate the financial institution
and account number where your money will be transferred.
You must verify these numbers and if incorrect, notify your
payroll officer immediately.
Cancellation of Direct Deposit requires Form ADM 4286 to be
completed and forwarded to your payroll officer.
If you change accounts and/or financial institutions, complete
form ADM 4286 for your old account and a new form ADM
4280 for your new account. Forward all materials to your
payroll officer. Remember your new account will go through
one pay period of pre-notification as indicated in item 11.
Therefore, you may not want to cancel your old account before
that time. In addition, this procedure will begin no earlier than
the pay period after receipt.
INSTRUCTIONS FOR AUTHORIZATION FOR DIRECT DEPOSIT OF PAY
1. Enter employee name as it appears on paycheck.
2. Enter the Social Security Number.
3. Enter the name and address of the financial institution (bank,
savings and loan, credit union, etc.) in which you want your
check deposited.
4. Enter your financial institution’s “Transit/ABA Number.” This
is a nine digit number and is shown on your personal check
and/or deposit ticket. Please verify this number at the
financial institution. If you elect to deposit in a savings
account, contact your bank for its Transit/ABA Number.
5. Check the type of account, checking or savings.
6. Enter your personal account number. You can obtain your
account number from your bank statement or your savings
account passbook. Otherwise, contact your financial
institution for your account number.
7. Sign Authorization Form and enter date.
8. Enter the agency where you work.
9. If you elect to deposit in a checking account, please attach a
voided check or a deposit ticket.
10. Forward the signed authorization and attachment to your
payroll officer.
11. For one pay period after the effective date of your authorization,
your earnings statement will indicate the financial institution
and account number where your money will be transferred.
You must verify these numbers and if incorrect, notify your
payroll officer immediately.
Cancellation of Direct Deposit requires Form ADM 4286 to be
completed and forwarded to your payroll officer.
If you change accounts and/or financial institutions, complete
form ADM 4286 for your old account and a new form ADM
4280 for your new account. Forward all materials to your
payroll officer. Remember your new account will go through
one pay period of pre-notification as indicated in item 11.
Therefore, you may not want to cancel your old account before
that time. In addition, this procedure will begin no earlier than
the pay period after receipt.