Amazon 2025

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The document is an In-Home Supportive Services Provider Direct Deposit Enrollment/Change/Cancellation Form from the California Department of Social Services. It outlines the process for providers to enroll in, change, or cancel their direct deposit for payments. The form requires personal and banking information, including case and provider numbers, and emphasizes that incomplete forms will be returned. It also provides instructions on how to fill out the form and where to send it.

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Click ‘Get Form’ to open the amazon form in the editor.
Begin by entering your personal information. Fill in your first name, middle initial, last name, street address, city, state, and zip code in the designated fields.
Select the appropriate box for your request: NEW to enroll in direct deposit, CHANGE to update your bank account details, or CANCEL to revoke your authorization.
Provide your case number and provider number as required. These can be found on your IHSS Statement of Earnings.
Indicate whether you want your funds deposited into a checking or savings account by checking the corresponding box.
Enter your bank's routing number (9 digits) and account number. If unsure, consult with your bank for assistance.
Sign and date the form at the bottom. Remember that an original signature is required; photocopies will not be accepted.

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