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The Direct Deposit Authorization Sign-Up Form for Los Angeles participants is a critical document for individuals receiving benefits from the Department of Public Social Services (DPSS). This form serves to facilitate the direct deposit of cash benefits into a designated bank account, streamlining the payment process for recipients. The form contains several essential sections. First, Section 1 requires the payee to provide personal details, including their name, case number, account type, and contact information. Accurate completion of this section is vital, as it directly affects the processing of the direct deposit request. Furthermore, the payee must certify their authorization for DPSS to deposit benefits into the specified bank account and acknowledge that DPSS holds no responsibility for transactions occurring after deposits are made. Section 2 is designated for completion by the depository institution, which requires details such as the bank's name, the routing number, and the account number. The bank also certifies the identity of the payee and confirms that it will accept direct deposit payments from the County of Los Angeles. Additional instructions emphasize the importance of matching personal information with existing records to prevent application rejection. Guidance on cancellation or changes to direct deposit arrangements further ensures that participants understand their responsibilities in managing their banking details. Overall, this form is designed to create a seamless process for benefit recipients while safeguarding their financial information.

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DIRECT DEPOSIT AUTHORIZATION SIGN-UP FORM - PARTICIPANTS

Department of Public Social Services

To sign up for direct deposit, the payee is to read the back of this form and fill in the information requested in Sections 1 and 2 to convert your case to direct deposit. Please print and fill this form out completely.

SECTION 1 (To be completed by the Payee - Please Print)

Payee Name: (Last, First, Middle) )

Case Number: (LDRP+Case Number+Payee ID)

 

LDRP ___ ___ ___ ___ ___ ___ ___

___ ___

 

(Case Number)

 

(Payee ID*)

Case Name: (if different than payee)

Type of account: (circle one)

 

 

 

Checking

Savings

 

 

 

Address:

Payee’s Social Security Number/Taxpayer ID#:

City, State and ZIP Code:

Telephone Number:

Payee Certification

This authorizes and instructs the Department of Public Social Services (DPSS) to deposit cash benefits to which I am entitled directly into the account at the depository institution designated in Section 2 below. I understand that DPSS’ obligation is limited to the direct deposit of public assistance payments. DPSS is not responsible for withdrawals from the account, including garnishments, after benefits are deposited. I understand that this authorization is to remain in full force and effect until DPSS has received notice as specified below of any change to these instructions. I agree to immediately notify DPSS in writing if I am removed from the account or it is closed for any reason. I understand that if my account is closed without providing DPSS at least five business days written notice, my cash benefits may be delayed. I agree to give DPSS five (5) business days written notice of withdrawal of my authorization or other change to these instructions.

Signature: ____________________________________________

Date: _______________________

Payee

SECTION 2 (To be completed by Depository Institution) – (Bank, Credit Union, etc.)

 

Name of Depository Institution:

Depositor’s name on account: (list all account

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

holders)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of Depository Institution:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Account Holder’s Primary/Secondary Social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security Number/s:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Routing Number:

Account Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depository Institution Certification

I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named depository institution, I certify that the depository institution agrees to receive and deposit payments from the County of Los Angeles.

Representative’s Name: __________________________________________________

Telephone:___________________________

Representative’s Signature: ________________________________________________

Date: ______________________________

 

 

 

 

 

 

COUNTY USE ONLY

 

 

DPSS Staff

Auditor-Controller Staff for eCAPS Entry

Attach the following LEADER

DEPARTMENT CODE: SS

BUSINESS TYPE: LDRP CERTIFICATION NO.: 7 Digit Case #

VENDOR/CUSTOMER CODE: Use full 13 Digit Case Number from “SECTION 1”

Screen Prints:

 

[LDRP+Case Number+Payee ID]

1.

Case Profile

 

ORG TYPE: Individual

ORG CLASS: Individual

2.

Case Payee *

ADDRESS TYPE: Payment

ADDRESS ID: 001

* Payee ID found on Case Payee screen

EFT FORMAT: PPD1

EFT STATUS: Prenote Requested

 

 

PA 1675 (Rev: 6/05) Participants

PLEASE READ THIS CAREFULLY

The information provided on this form will remain confidential and be kept by the Department of the Auditor- Controller on behalf of Los Angeles County. Failure to provide the requested information may affect the processing of this form and may delay or prevent the receipt of benefits through the Direct Deposit Program.

Return this form with the computer screen printouts attached by your Eligibility Worker to the Auditor-Controller using the envelope provided to you. If you did not receive an envelope to mail this form please return this form to:

Los Angeles County Auditor-Controller

P.O. Box 7000

Downey, CA 90241-9907

Instructions For Completing This Form

Print clearly and complete Section 1 of this form.

Write the payee name exactly as it appears on the printout.

Make sure the address on the printout provided by your Eligibility Worker is your current address. The County will reject applications if the address on the application does not match the printout.

Write your Case Number and Payee ID exactly as it appears on the printout.

If you want your cash benefits deposited into your checking account, attach a voided personal check to this form, and write, “VOID” on the front of the check OR ask your depository institution to complete Section 2. If you want your cash benefits to be deposited into your savings account, or into any credit union account, (checking or savings) a representative from your depository institution MUST complete Section 2.

If the address on your personal check is different from your current address, cross out your old address and print your new address on your personal check. The address printed or handwritten on your check must match your application and the printout provided by your Eligibility Worker.

Cancellation

Direct deposit will remain in effect until cancelled by either yourself or DPSS. To stop direct deposit, call your Eligibility Worker and request a PA 1675-3, Cancellation for Direct Deposit Form. If you or your depository institution closes your bank account, you must report the account closure to avoid delays in receiving your benefits.

Changing Depository Institutions

To change depository institutions for direct deposit, you must complete a Cancellation for Direct Deposit Form and a new Direct Deposit Sign-Up Form. Return all forms with computer screen printouts attached by your Eligibility Worker to the Auditor-Controller using the envelope provided to you. If you did not receive an envelope to mail the forms, please return them to:

Los Angeles County Auditor-Controller

P.O. Box 7000

Downey, CA 90241-9907

It is recommended that you maintain accounts at both depository institutions until the new depository institution receives the first direct deposit.

PA 1675 (Rev: 6/05) Participants

Document Specifications

Fact Name Description
Purpose of the Form This form is used for authorizing direct deposit of public assistance benefits into a bank account.
Sections Required The form consists of two sections: Section 1 for the payee's information and Section 2 for the depository institution details.
Account Types Payees can choose either a checking or savings account for direct deposit.
Confidentiality All information on this form is confidential, safeguarded by the Department of the Auditor-Controller for Los Angeles County.
Notification Requirement Payees must notify DPSS in writing of any account changes or if removed from the account to avoid delays in benefits.
Governing Laws This form is governed by California state laws regarding public assistance and financial transactions.
Submission Process Completed forms must be returned with computer screen printouts attached to the Auditor-Controller using the envelope provided or sent directly to their office.

Steps to Filling Out Direct Deposit Los Angeles

Filling out the Direct Deposit Los Angeles form requires careful attention to detail to ensure that all necessary information is provided accurately. Once completed, the form should be submitted to the appropriate department for processing.

  1. Obtain the Form: Make sure you have the Direct Deposit Los Angeles form either from a physical copy or by downloading it online.
  2. Section 1 Completion: In the first section, write your name in the format of Last, First, Middle.
  3. Fill in Your Case Number: Locate your case number and Payee ID, and write them in the specified format: LDRP followed by the Case Number and Payee ID.
  4. Identify Your Case Name: If it differs from your name, include it in the designated area.
  5. Select Account Type: Circle either "Checking" or "Savings" to indicate the type of account you wish to use.
  6. Complete Your Address: Provide your current address, including city, state, and ZIP code.
  7. Enter Social Security or Taxpayer ID: Include your Social Security Number or Taxpayer ID.
  8. Provide a Phone Number: Include a contact number where you can be reached.
  9. Read the Certification: Familiarize yourself with the certification clause which explains your authorization for direct deposit.
  10. Sign and Date: Sign the form to certify the information provided is accurate, and date your signature in the given space.
  11. Section 2 Completion: If depositing into a savings account or credit union, the institution must fill out this section. Include the name and address of the institution.
  12. List Account Holders: If applicable, write the names of all account holders associated with the account.
  13. Provide Account Information: Input the Routing Number and Account Number necessary for the direct deposit.
  14. Institution Certification: Have a representative from your depository institution sign and date this section, confirming the details.
  15. Review and Attach: Before submitting, review the form to ensure all sections are complete. If depositing to a checking account, attach a voided check. If depositing to a savings account, ensure Section 2 is completed by the institution.
  16. Submit the Form: Return the completed form to the specified department using the provided envelope or send it to the Los Angeles County Auditor-Controller at the address given.

More About Direct Deposit Los Angeles

What is the purpose of the Direct Deposit Los Angeles form?

The Direct Deposit Los Angeles form is used to authorize the Department of Public Social Services (DPSS) to deposit public assistance payments directly into a designated bank account. By completing this form, participants ensure that their cash benefits are deposited automatically, simplifying the process of receiving funds.

What information do I need to provide in Section 1 of the form?

In Section 1, the payee must fill out crucial personal information. This includes the payee’s full name, case number, case name (if different), account type (checking or savings), and the payee’s Social Security number or Taxpayer ID. Additionally, you must provide your current address and telephone number. Accurate information is necessary to avoid delays in processing and potential rejection of the form.

How do I know if my direct deposit has been set up successfully?

What should I do if I want to cancel my direct deposit?

To cancel your direct deposit, you need to contact your Eligibility Worker and request a Cancellation for Direct Deposit Form, known as PA 1675-3. Fill out this form promptly and return it as directed. It is essential to make this request as soon as possible to avoid complications or delays in receiving future benefits.

Can I change my bank account for direct deposit?

You can change your bank account for direct deposit by completing a Cancellation for Direct Deposit Form and a new Direct Deposit Sign-Up Form. It is essential to maintain accounts at both the old and new institutions until the new account receives its first deposit. Submit all forms alongside any necessary documentation to ensure a smooth transition.

What happens if I do not provide accurate information on the form?

Failure to provide accurate information on the Direct Deposit Los Angeles form may lead to processing delays or the rejection of your application. It is vital to carefully review all details before submission. Mismatched addresses or incorrect account information can directly affect the timely receipt of your benefits.

Common mistakes

  1. Using an incorrect name: Payees often fail to match their names as they appear on official documents. It is critical that the payee name mirrors what’s on the printout.

  2. Incorrect case number: Some individuals mistakenly input a case number that does not correspond to their records. Ensure this number matches the printout exactly.

  3. Missing Social Security number: Not providing the payee’s Social Security Number or Taxpayer ID can lead to a rejected application. Double-check this information is complete and accurate.

  4. Address discrepancies: Failing to ensure the address on the form matches the approved address on the printout can result in delays. Update addresses as needed.

  5. Selecting incorrect account type: Some payees neglect to properly indicate whether the deposit should go into a checking or savings account. This detail is essential.

  6. Skipping Section 2: Individuals sometimes forget to have their depository institution complete Section 2, especially if they're using a savings account. This is necessary for processing.

  7. Not attaching documentation: When required, many forget to attach a voided check or the proper documentation needed for account verification. This can stop the process completely.

  8. Ignoring certification requirements: Payees often neglect to sign the form, leading to a lack of authorization for processing. Signatures are a must.

  9. Failure to report changes: Some may not understand the importance of notifying the DPSS about account changes or closures, which could delay benefits.

  10. Not following submission guidelines: Payees can overlook the specific instructions on how and where to submit the completed form, risking further delays in processing. Always send it to the right address.

Documents used along the form

When enrolling in direct deposit through the Los Angeles County Department of Public Social Services, several additional documents may be required to ensure a smooth process. Here is a list of other forms and documents commonly used alongside the Direct Deposit Authorization Sign-Up Form.

  • Voided Check: If you're setting up direct deposit into a checking account, a voided check may be required. This check, marked “VOID,” helps verify account details.
  • Cancellation for Direct Deposit Form: If you wish to stop direct deposit, this form is needed. It formally requests the cancellation of your existing direct deposit setup.
  • Bank Statement: Sometimes, a recent bank statement verifies account ownership and details. This document helps ensure that your information matches what is on file.
  • ID Verification: Depending on the institution, you might need to provide a form of identification. This could be a driver's license or state ID to confirm your identity.
  • Social Security Card: Providing your Social Security card can be necessary for confirming your taxpayer ID or Social Security number within the direct deposit setup.
  • Eligibility Verification Documents: These may include forms that verify your eligibility for the benefits you are applying for or already receiving.
  • Proof of Address: Documents like utility bills or lease agreements can serve as proof of your current address, ensuring continuity in your benefit payments.
  • Account Closure Notification: If you're changing your account for direct deposit, you might need to submit proof of closure from your previous bank to avoid risks of delayed payments.

Having these documents ready can help streamline the direct deposit setup process and prevent unnecessary delays. It's always best to double-check with your Eligibility Worker to ensure you have everything required for your specific situation.

Similar forms

The Direct Deposit Authorization Sign-Up Form is similar to a Payroll Direct Deposit Form. Both documents facilitate the direct deposit of funds into a bank account. The Payroll Direct Deposit Form is often used by employees to authorize their employer to deposit their wage payments directly into their personal bank accounts. Like the Direct Deposit Los Angeles form, it requires specific account information, including the account holder's name, the bank’s routing number, and the account number. Both forms serve to streamline payment processes, ensuring timely access to funds.

Another document comparable to the Direct Deposit Los Angeles form is the Automatic Payment Authorization Form. This form allows individuals to authorize a company or service provider to withdraw payments directly from their bank account. Both forms emphasize consent and require accurate banking information. While the Direct Deposit Los Angeles form relates specifically to receiving public assistance benefits, the Automatic Payment Authorization Form typically pertains to recurring bill payments, showcasing a similar mechanism for securing financial transactions on either end.

The Direct Deposit Change Request Form also aligns closely. This form is used when an individual wishes to update their banking information for direct deposits. Similar to the Direct Deposit Los Angeles form, it involves completing personal and account details. Both documents require the individual to certify their identity and the validity of the banking information provided. They ensure continuity of payments, helping to prevent missed deposits due to outdated account details.

Finally, the Vendor Direct Deposit Form bears a resemblance to the Direct Deposit Los Angeles form. This form serves vendors who wish to receive payments directly to their bank accounts for services rendered or goods provided. Both documents necessitate accurate account information and ensure that proper authorization is granted for the transactions. While the Direct Deposit Los Angeles form is specific to public assistance payments, the Vendor Direct Deposit Form has a broader application, highlighting the principle of direct deposits across various contexts.

Dos and Don'ts

When filling out the Direct Deposit Los Angeles form, keeping certain guidelines in mind can help ensure a smooth process. Here’s a list of things you should and shouldn’t do:

  • Do read the entire form carefully before starting to fill it out.
  • Do use clear, legible handwriting when printing your information.
  • Do verify that the payee name matches exactly with the name on your eligibility printout.
  • Do provide accurate account details to avoid any processing delays.
  • Do notify DPSS in writing if there are changes to your account status.
  • Don't forget to attach a voided personal check if choosing direct deposit into a checking account.
  • Don't leave any required fields on the form blank; this could result in rejection.
  • Don't use an old address that doesn't match your current information.
  • Don't ignore instructions regarding notification of account closures or changes.
  • Don't submit your application without confirming all information matches your eligibility printout.

By adhering to these recommendations, you can facilitate a faster and more efficient processing of your direct deposit application.

Misconceptions

Misconception 1: Direct deposit is only for those with bank accounts.

Many believe that direct deposit can only be set up if you have a traditional bank account. However, direct deposit can also be arranged for savings accounts or credit union accounts, as long as the financial institution supports this service.

Misconception 2: You need perfect credit to use direct deposit.

Some worry that they will not qualify for direct deposit due to their credit history. In reality, direct deposit eligibility does not depend on your credit score; it is simply a method for receiving payments.

Misconception 3: Once set up, you never have to think about direct deposit again.

Although direct deposit is convenient, it is essential to inform the Department of Public Social Services (DPSS) if your banking details change. Failing to do so can result in delays or complications in receiving your benefits.

Misconception 4: You will be charged fees for direct deposit.

People often think that using direct deposit will incur extra fees. Generally, there are no additional charges from the DPSS for using this service, but it is advisable to check with your bank regarding any potential fees.

Misconception 5: Everyone automatically receives their funds through direct deposit.

Not everyone is enrolled in direct deposit. You must fill out and submit the Direct Deposit Authorization Sign-Up Form to receive your benefits this way.

Misconception 6: Direct deposit is less secure than receiving a physical check.

Some believe that receiving funds directly into an account is less secure. In fact, direct deposits are often more secure than paper checks, which can be lost or stolen during delivery.

Misconception 7: There is no way to track direct deposits.

Many assume that they cannot track their deposits. However, you can monitor your account statements or check your online banking portal for deposit records.

Misconception 8: You cannot change banks once you have signed up.

A common belief is that you are locked into one bank after setting up direct deposit. You can change your depository institution by completing the proper forms and notifying DPSS.

Misconception 9: Direct deposits always arrive on the same day each month.

While many expect funds to arrive on a specific date, actual deposit dates may vary due to holidays or weekends. It is wise to anticipate these fluctuations.

Misconception 10: If I close my bank account, my benefits will be automatically redirected.

It is critical to inform DPSS promptly if your bank account is closed. Otherwise, your benefits may be delayed, and you could encounter payment issues.

Key takeaways

Here are key takeaways for filling out and using the Direct Deposit Los Angeles form:

  • Complete the form accurately, ensuring all requested information is provided.
  • The payee’s name must match the records exactly as listed.
  • Double-check your case number and payee ID; any discrepancies may lead to rejection.
  • Specify the type of account: checking or savings.
  • Write your current address as seen on the eligibility printout; mismatches can cause delays.
  • For checking accounts, attach a voided check or have your bank complete Section 2.
  • For savings or credit union accounts, Section 2 must be completed by the financial institution.
  • Notify the Department of Public Social Services (DPSS) of any changes to your account promptly.
  • Direct deposit will remain active until you or DPSS cancels it.
  • If changing banks, complete a cancellation form along with the new direct deposit form.

Following these steps ensures a smooth enrollment in direct deposit, minimizing delays in receiving benefits.