Get Dss 5023

Filling out the Dss 5023 form, also known as the Direct Deposit Enrollment Authorization Form, is a crucial step for users wanting to receive payments electronically. This guide provides step-by-step instructions to ensure a smooth and efficient completion of the form online.

Follow the steps to successfully fill out the Dss 5023 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, enter the name of the case head in the format: last name, first name, middle initial.
3. Provide the case head's Social Security Number (SSN) and home telephone number.
4. If the payee differs from the case head, enter the name of the payee and their SSN.
5. Select the gender option and indicate the type of account (checking or savings).
6. Fill in the name(s) on the bank account and specify the bank name.
7. Enter the account number and case head/payee’s address, including street, city, state, and zip code.
8. Include the date of birth (DOB) and preferred language of the payee.
9. Provide the payee’s telephone number.
10. Authorize the Department of Social Services (DSS) to make deposits to the specified bank account.
11. Attach a voided or cancelled check to complete this authorization. If you do not attach a check, follow the instructions for Section 2.
12. Print your name, sign, and date the form. If applicable, print the name of the payee, sign, and date as well.
13. For Section 2, if applicable, have your bank provide the necessary information, including routing number, account number, and bank representative’s name.
14. Ensure that you circle the applicable program area: WFFA, SA, SA In-Home, or RCA.
15. Once the form is completed, save your changes and ensure to keep a copy for your records.

Complete your Dss 5023 form online today to initiate your Direct Deposit!