PLEASE SIGN AND DATE HERE TO ACCEPT THE
TERMS AND CONDITIONS OF THIS FORM
University of Connecticut Payroll Department
343 Mansfield Road, Unit 1111, Storrs, CT 06269
SECTION I EMPLOYEE INFORMATION
NAME OF BANK OR FINANCIAL INSTITUTION
TYPE OF ACTION (Check only one)
SECTION IV AUTHORIZATION AGREEMENT
SECTION III POLICIES & DEFINITIONS
CLOSING A DIRECT DEPOSIT ACCOUNT: Do not close, cancel, or change an existing direct deposit account without first submitting an
updated direct deposit form to the Payroll Department. Failure to notify the Payroll Department of a change to your account may result in
delayed payment(s). Please note that a direct deposit account will remain in effect until you request to have it inactivated (except in the
case of a separation from the Classified or Unclassified payroll).
CHANGING A DIRECT DEPOSIT ACCOUNT: Changes to direct deposit accounts generally take two pay periods to process. An actual
check will be issued between the inactivation of your current account and the activation of your new account.
PRE-NOTE PROCESS: Each new direct deposit account that is entered into the State's Core-CT system must pass the State's "pre-note
process." During this period, paper checks continue to be issued while the new account is tested. A $0.01 deposit will be made to the
account on the pay date preceding the direct deposit effective date.
ESTABLISHING A SECONDARY ACCOUNT: You must have one existing account that has successfully completed the pre-note process
in order to add an additional account. New employees, or employees who are requesting direct deposit for the first time, are not permitted
to request an additional account until an initial account has successfully completed the pre-note process. Once you have begun receiving
payments to your initial account you may request a secondary account by submitting a Secondary Direct Deposit Authorization
Agreement.
ACCOUNT TYPE (Check only one)
INSTRUCTIONS: Complete this form if you wish to establish, change, or cancel a direct deposit account with the State of Connecticut and the University of
Connecticut. Please note that this form will affect payments issued from all State payrolls regardless of agency and all payments from Accounts Payable and
Travel Service offices at the University of Connecticut. If you have any questions regarding direct deposit, please contact the University Of Connecticut
Payroll Department at (860) 486-2423. This form is not intended for State of Connecticut retirees, as all retiree direct deposit records are administered by the
State's Retirement Division.
I hereby authorize the State of Connecticut ("STATE") and the University of Connecticut ("UCONN") to electronically deposit all deduction
monies owed to me to the bank named above. This authorization is to remain in force until such time that the STATE and UCONN has
received written notification from me of its termination in such time and manner as to afford the STATE, UCONN and the bank named
above a reasonable opportunity to act upon it. In the event that the STATE and UCONN notifies the bank that the funds have been
deposited to my account in error, I hereby authorize and direct the bank to return said funds to the STATE and UCONN as soon as
possible. In the event such funds have been drawn from that account so that the return of those funds by the bank to the STATE and
UCONN is not possible I hereby authorize the STATE and UCONN to recover those funds by deducting the amount of said funds from
any future payments from the STATE and UCONN until the amount of the erroneous deposit has been recovered in full. I further agree
that if I do not immediately repay an erroneous deposit, I will be personally liable for all costs of collection, including reasonable attorney's
fees incurred by the STATE and UCONN in the collection of such erroneous deposit, together with the maximum interest permitted by
law.
Furthermore, I authorize UCONN to use the account information provided above for all payments from Accounts Payable and the office
of Travel Services.
FIRST NAME & MIDDLE INITIAL
UNIVERSITY OF CONNECTICUT
(Not to be used to establish/change a secondary direct deposit account)
DIRECT DEPOSIT AUTHORIZATION AGREEMENT
SECTION II ACCOUNT INFORMATION
