Texas direct deposit authorization form 2026

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The document is a Direct Deposit Authorization form for vendors, individual recipients, or state employees in Texas to set up, change, or cancel direct deposit information for payments from the state. It includes sections for transaction type, payee identification, financial institution details, international payment verification, and authorization. The form also outlines rights under government code regarding personal information.

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Click ‘Get Form’ to open the Texas Direct Deposit Authorization Form in our platform's editor.
In Section 1, select the appropriate transaction type: New setup, Change financial institution, Change account number, Change account type, or Cancellation. This helps specify your request.
Move to Section 2 for Payee Identification. Choose your payee type (State employee or Vendor), and enter your Texas Identification Number (TIN), Employer Identification Number (EIN), or Social Security Number (SSN). Fill in your name, phone number, and mailing address.
In Section 3, provide details about your Financial Institution. Include the institution's name, city, routing transit number (9 digits), customer account number, and type of account (Checking or Savings).
Section 4 requires you to verify if payments will be forwarded internationally. Select 'YES' or 'NO' accordingly.
Complete Section 5 by authorizing the setup, changes, or cancellation. Ensure you sign and date this section for it to be valid.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (152 Votes)
2020	4.8 Satisfied (92 Votes)
2017	4.3 Satisfied (88 Votes)
2012	4.7 Satisfied (63 Votes)

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Earnings - Pay stubs or copy of checks dated within sixty days from the date you submit your application or renewal application, a statement from employer that includes their name, address and phone number or self-employment records.

What is a 74 176 form for Medicaid in Texas?

A direct debit form is an application form that you must fill in which provides your details. This confirms that you give permission for your account to be debited.

What is the Texas Medicaid disclosure of ownership form?

Form 5871-S is completed and submitted as a condition of approval or renewal of a Texas Medicaid enrollment application or a contract agreement between the disclosing entity (applicant/provider) and HHSC for any services program. A full and accurate disclosure of ownership and control interest is required.

What is a 74 176 direct deposit authorization?

This form is used by vendors, employees and individual recipients to: Receive payments from the state of Texas by direct deposit. Change or cancel existing direct deposit information.

What is a direct debit authorization form?

I hereby voluntarily authorize the Company named above (hereafter Employer), either directly or through its payroll service provider, to deposit any amounts owed me, by initiating credit entries to my account (s) at the financial institution (s) of my choice (hereinafter Bank) indicated on this form.

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How do I get a direct deposit authorization form?

Direct Deposit Authorization Form (74-176) This form is used by vendors, employees and individual recipients to: Receive payments from the state of Texas by direct deposit. Change or cancel existing direct deposit information.