The employee's name must appear on the account(s). If you would like to begin Direct Deposit or modify how your funds are distributed, you must complete Form AC 2772 with your banking information.Fill in the area labeled "account holder's name" and "address" with your full name and address. Provide First and Last Name. 2. Complete all the information below. Sign and date the bottom of the form. Bank name: The name of the employee's bank or credit union where they want their paychecks to be sent. Please note: the direct deposit form is only available for injured workers whose workers' compensation claim is filed in the State of New York.