Department of Financial Services
Division of Accounting and Auditing – Bureau of Vendor Relations
DFS-A1-26S, Rev. 03/2014
Employee Direct Deposit Authorization
New request Change request Stop request
Instructions and important information:
• All forms received must be complete and must be signed by
the employee.
• The social security number is required to be collected
pursuant to 26 USC 6109, and will only be used for the
purpose of complying with filing requirements imposed by the
Internal Revenue Code and to comply with Section
119.071(5)(a)7, F.S.
• Select the appropriate action:
• New request - If a payee does not currently have direct
deposit with the state.
• Change request –If payee has a current direct deposit
with the state and is requesting a change. (example:
change of payee name, account number and etc)
• Stop request – if a payee wishes to stop an active direct
deposit authorization
• Submit a copy of a valid driver’s license or government
issued identification at the time the original Direct
Deposit Authorization Form is filed, per the
requirements outlined in 69I-22.003(3) Florida
Administrative Code. Forms without a copy of a
driver’s license will not be approved.
• The name on the form must match the name on your Form
W-4 on file with your personnel office. If you change your
name on your W-4, you also must change your name for
direct deposit.
• The authorization will remain in effect until terminated in
writing. The State will not be responsible for any loss that may
arise solely by reason of error, mistake or fraud regarding
information provided on this Direct Deposit Payment
Authorization Form.
• Banking industry rules require the State, as originator of
electronic payments, to identify payments where the entire
payment amount is subsequently transferred to a financial
institution outside the United States. The rules are referred to
as “International ACH Transaction (IAT) rules” and are
pursuant to requirements of the United States Treasury Office
of Foreign Assets Control (OFAC). Florida will not send IAT
payments; these payments will be made by state warrant.
Contact your Financial Institution to see if IAT rules apply to
you.
•
A voided personal check can be submitted with the Direct
Deposit Authorization request. Tape the check over the
form’s instructions. The check will be used to confirm the
financial institution information.
Social Security
number
Last Name
Suffix
First Name
Middle
Initial
number
Email
address
City
State
ZIP
Financial Institution
Name
Suncoast Credit Union
Financial Institution
800-999-5887
Routing Number
2
6 3 1 8 2 8 1 7
Account
Number
Account
Checking Savings
Check this box if your funds are deposited in a U.S. financial
institution and the entire amount is then forwarded to a financial
institution in a foreign country. (IAT)
I hereby authorize and request the State of Florida to initiate credit
entries and, if necessary, a debit entry in accordance with NACHA rules
reversing a credit entry made in error, to my account at the financial
institution named. This direct deposit is to remain in effect until
withdrawn by: (a) me in writing with sufficient notice to the State to allow
adequate time to effect termination; (b) my death or legal incapacity; (c)
the financial institution or (d) the State of Florida. It will purge
approximately six (6) months after my last wage.
Signature Date
Mail the form to the address below or fax it to (850) 413-5549
Department of Financial Services
Direct Deposit Section
200 East Gaines Street
Tallahassee, Florida 32399-0359
For prompt authorization, complete your EFT request through
People First at https://peoplefirst.myflorida.com. If completed
online, your request will be active within two weeks. Paper Direct
Deposit Authorization forms are processed in the order in which
they were received; allow 4-6 weeks for processing.
