Get Direct Deposit/electronic Funds Transfer (eft) Authorization ...

Completing the Direct Deposit/Electronic Funds Transfer (EFT) Authorization form is essential for ensuring that payments are deposited directly into your bank account. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the authorization form successfully.

1. Press the ‘Get Form’ button to access the form and have it ready for completion.
2. In Section 1, indicate the type of transaction by checking either 'Add', 'Change', or 'Close'. Fill in your provider name, and select your Federal Identification Number (FIN) or Social Security Number (SSN) accordingly.
3. In Section 2, provide the name and address of your bank, the routing number, the account holder name, and the depositor account number. Select the type of depositor account (checking or savings). Remember that a voided check or bank verification is required for checking accounts, while savings accounts need bank-printed verification.
4. Once everything is correctly filled out, mail the original authorization form along with your voided check or bank verification to the designated address: Department of Health and Human Services, Division for Children, Youth and Families – Provider Relations, 129 Pleasant Street, Concord, NH 03301.
5. Lastly, keep a copy of the completed form for your records and to track any future communications regarding changes.

Start completing your Direct Deposit/EFT Authorization form online today to ensure timely payments.