Dss 5023-2026

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The document is a Direct Deposit Enrollment Authorization Form for Special Assistance payments, effective July 2013. It outlines the transition from paper checks to electronic payments, detailing the benefits of Direct Deposit, the enrollment process, and requirements for signing up. It also explains how Direct Deposit works, who is eligible, and how to stop the service if needed.

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Click ‘Get Form’ to open the dss 5023 in the editor.
Begin with Section 1, entering your name as the Case Head, Social Security Number, and home telephone number. If applicable, provide the Payee's information.
Select the type of account (Checking or Savings) and fill in the bank details including Account Number and Bank Name.
Attach a voided or cancelled check if you are using a checking account. If not, ensure your bank completes Section 2.
Sign and date the form at the bottom of Section 1. Ensure that all names on the account match those provided in the form.
Once completed, return the form to your caseworker and keep a copy for your records.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (87 Votes)
2013	4.6 Satisfied (58 Votes)

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