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Click ‘Get Form’ to open the DHS-1377 in the editor.
Begin by checking the appropriate box at the top of the form to indicate whether you are submitting a new authorization, changing an existing one, or canceling your current authorization.
In the 'Your Name' section, print your last name, first name, and middle initial clearly. This ensures accurate identification.
Provide your phone numbers in the designated fields for home, work, and any other contact number. Include extensions if applicable.
Fill in your current or new address completely, including street number, city, state, and zip code.
Enter your Social Security Number and case ID or court case number as required. Ensure accuracy for proper processing.
Specify your bank details by entering the bank name, routing number (9 digits), and account number (up to 17 digits).
If you have a checking account, write 'VOID' on an unused check and attach it. For savings accounts, obtain written verification from your bank and attach it.
Sign and date the form at the bottom to authorize electronic deposits into your designated account.
Finally, mail this completed form to MiSDU at the provided address or fax it as indicated.
Start using our platform today for free to easily complete your DHS-1377 form!
Fill out DHS-1377, Direct Deposit Authorization Form. DHS-1377 online It's free
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DHS-1377 - Michigan Department of Health Human Services
DIRECT DEPOSIT AUTHORIZATION. Michigan Department of Health and Human Services. Michigan State Disbursement Unit. Check one box and complete the entire form.Read more
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