Arizona Direct Deposit Form 1

Information Regarding Direct Deposit
♦--Please read carefully – improper submissions may delay the Direct Deposit process--♦
Direct deposit is the electronic transfer of your weekly Unemployment Insurance payment into your bank account.
Direct deposit eliminates mailing delays, the possibility of a check being lost or stolen and alleviates the need to go
somewhere to cash or deposit your check. When you sign up for direct deposit, you are giving the Department of
Economic Security permission to credit your bank account.
To sign up for direct deposit, complete the application form on the next page. The form is interactive—you can
complete it on your PC and print it. In order to process your request for direct deposit, you must provide the bank
routing and account numbers from the financial institution where the account is maintained. These codes are
posted on your checks. For direct deposits into either a checking or savings account—a blank check with VOID
written across the front must be mailed with your completed form. If you do not have a blank check, you must have
your financial institution complete Section A (on page two of the Direct Deposit Agreement form).
♦-- DO NOT SEND A DEPOSIT SLIP --♦
Deposit slips do not have the necessary codes to set up direct deposit
and will not be accepted.
Submitting anything other than a voided check or the completed
Section A of the Direct Deposit Agreement form will delay the process.
Mail your completed application along with a voided check or Section A of the Direct Deposit Agreement form
which has been completed by your financial institution to:
Arizona Department of Economic Security
Employment Administration
PO Box 21106
Phoenix, AZ 85036-1106
♦--IMPORTANT NOTE--♦
The above address is to be used only for mailing direct deposit forms.
If you send other correspondence or materials to this address, it could delay
receipt by the party for whom it is intended.
Before direct deposit can begin, a test transaction will be sent to your bank or credit union to verify your routing and
account numbers. This normally takes 10 days and you will continue to receive any benefit payments you are entitled
to by check during this period.
Payments are usually posted to your account two working days after the funds are transferred. You can see when
your payment was transferred by accessing AZUI.COM, selecting “File Your Weekly Claim Online” from the menu
on the left of the page and then “View Payment Information” from the drop-down menu. If you choose to file your
weekly claims by telephone using TIPS (Telephone Information and Payment System), payment inquiries are
available through Option 2. You will need to contact your bank or credit union to determine when the benefit payment
is actually posted to your checking or savings account.
♦--If there are any changes to your bank or credit union account, must notify us immediately--♦
Changes to your bank or credit union account must be provided in writing to the address shown above. A new form
must be completed and mailed to the department if you close or change your checking or savings account. If you
change your account and wish to continue with direct deposits, you must include a blank check from the new
account with VOID written across the front or a newly completed Section A. The reported change will be verified
with your bank or credit union. As with the initial application for direct deposit, this verification will take approximately
10 days and you will receive any benefit payments made during this time by check.
Arizona Department of Economic Security
Employment Administration
Agreement for Direct Deposit
Mail to:
Arizona Department of Economic Security
Employment Administration
PO Box 21106
Phoenix, AZ 85036-1106
Direct deposit Agreements will only be accepted by mail – do not fax.
Name:
✔
Social Security Number
I authorize the Arizona Department of Economic Security, Employment Security Administration, to make
automatic deposit of the full amount of any payments of my weekly unemployment benefits to my:
Checking Account
Savings Account
I authorize the Arizona Department of Economic Security, Employment Security Administration, to terminate
the automatic deposit of any payments of my unemployment benefits.
I authorize the Arizona Department of Economic Security, Employment Security Administration, to change the
automatic deposit of any payments of my unemployment benefits to my:
Checking Account
Savings Account
•
ATTACH VOIDED CHECK FROM YOUR CHECKING OR SAVINGS ACCOUNT HERE
If a voided check is not available: take this form to your bank or credit union,
have a representative complete Section A on page 2, and
mail the completed form (both pages, if applicable) to the address shown above
•
I understand that the Arizona Department of Economic Security, Employment Security Administration, can
automatically deposit unemployment benefits only to a separate or joint banking account under which the name of the
above claimant is listed.
I understand that is my own responsibility to verify any such deposits of unemployment benefits with my
banking institution.
This authorization shall remain in effect until the Arizona Department of Economic Security has received written
notification from me to terminate or otherwise change the automatic deposit of my unemployment benefits. Such
notification shall be delivered in a timely manner in order to afford the Arizona Department of Economic Security an
opportunity to comply. In no event shall any such termination or change affect any unemployment benefits previously
processed or being processed by the Arizona Department of Economic Security for automatic deposit at the time of
receipt of my notification.
In the event of an error in the automatic deposit of my unemployment benefits to my account, I authorize my named
banking institution to correct the error in my account. I understand that if an error is made, I shall receive written
notification from the Arizona Department of Economic Security with an explanation of such error.
I authorize my banking institution to release to the Arizona Department of Economic Security any account information
pertaining to my receipt and eligibility for unemployment benefits.
Signature: ____________________________________________________
Date: _______________________
Page 2
SECTION A – TO BE COMPLETED BY FINANCIAL INSTITUTION
NAME AND ADDRESS OF FINANCIAL INSTITUTION:
ROUTING NUMBER:
______________________________________________
ACCOUNT NUMBER:
FINANCIAL INSTITUTION CERTIFICATION
As representative of the above-named financial institution, I confirm the identity of the payee, the routing and account numbers.
PRINT/TYPE REPRESENTATIVE NAME
SIGNATURE OF REPRESENTATIVE
TELEPHONE NUMBER
DATE