Get Virginia Ecc Vendor Settlement Authorization Form - Public Dss State Va

Filling out the Virginia ECC Vendor Settlement Authorization Form can be straightforward when you have clear guidance. This form is essential for authorizing deposits and debits related to the Commonwealth of Virginia Child Care Subsidy Program.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and access it in the editor.
2. Select whether this is your first submission or if you are changing your banking information by choosing one of the following options: ☐ First Submission ☐ Change in Banking Info.
3. Indicate your status as either a business or individual by selecting one of the options: ☐ Business (has FEIN on file with VDSS) or ☐ Individual (No DBA, has SSN on file with VDSS). Next, complete the vendor information and select your payment method. Choose between 'DBA (Business Name)' and 'Authorized Individual Name', then select 'Account Type' (checking or savings). Enter your title, ABA bank routing number, address, account number, city/state/ZIP, and, if applicable, date of birth (DOB). Note: For individuals, you can also include a debit card option.
4. For checking accounts, make sure to attach a voided check. Deposit slips cannot be accepted as proof. You can also include a letter from your bank with the routing and account number information. For savings accounts, a deposit slip can be accepted, or you may include a letter from your bank. Important: Failure to follow Step 4 instructions may lead to delayed or incorrect fund deposits.
5. Once the form is fully completed, return it to Conduent State & Local Solutions, Inc. at the provided mailing address or fax it to the given number. Ensure that all information is accurate to prevent any issues.

Complete your document online today to ensure timely processing.