CALIFORNIA
˜°˛˝˙ˆˇ˘ˆˇ˛˜ˇ
INTERNATIONAL DIRECT DEPOSIT
The State of California offers a Direct Deposit program as a
faster, easier, and more secure
option for receiving your child support payments.
To enroll, simply ll out this form (in English only), then mail/email the form with a voided check, encoded
deposit slip, or a printed statement from your bank to the appropriate address located below.
California Department of Child Support Services
P.O. Box 989064
West Sacramento, CA 95798-9064 USA
casdu-electronichelpdesk@dcss.ca.gov
Note: You may need to contact your bank to obtain the bank information listed below, as it is different for your domestic transactions. In
addition, this form is only for participants enrolling in direct deposit to a bank located outside of the USA. If enrolling in direct deposit into a
USA bank account, please use the domestic Deposit Enrollment/Authorization Form.
* Indicates required elds
Personal Information
* Child Support Participant Number (Up to 15)
(if you do not have a California Participant Number, please contact
001-408-273-0073.)
* Name (Last, First,and Middle Initial)
Date of Birth (Month/Day/Year)
Social Security Number or ITIN (if applicable)
1
Individual Taxpayer Identication Number
1
* Address (Line 1)
Address (Line 2)
* City * State/Province
* Postal Code * Country
Phone Number (up to 17)
(Country Code if applicable - Area Code - Number)
Email Address if available
Bank Information
* Name of Financial Institution
(Bank or Credit Union)
* Bank ID (up to 34) See reference table on Page 2
* Account Number (up to 35) See reference table on page 2
* Bank Branch Country Name
* Bank Qualifier Code (See reference table on page 2)
For Bank Qualier Code type
01 = National Clearing System Number
02 = SWIFT BIC (bank identifier code)
03 = IBAN (international bank account number )
Note: Payments can only be sent in your country's local
currency.
Please attach supporting document(s) such as a voided
check, encoded deposit slip, or a printed (handwritten will not
be accepted) statement from your bank. It should include:
• Name (Last, First, Middle Initial)
• Account Number
• Bank ID
If you are emailing the form, please scan the supporting
document(s) and attach to the same email.
This form will be returned without the supporting document(s).
* Liability Release: By completing and submitting this form, I understand I am giving the California State Disbursement Unit (CA SDU) permission to deposit
payments directly into the bank account I have listed above. I have veried with my bank that the Bank ID and my Account Number are accurate. I
understand that if I have not provided accurate Bank ID and Account Numbers, the CA SDU and the California Department of Child Support Services are not
liable for any mistakes resulting from inaccurate Bank ID and Account Numbers. I assume responsibility to verify deposits to my Bank Account on a timely
basis and understand that I am responsible for any bank fees that my nancial institution may charge. This authorization is to remain in full force and in effect
until 1 cancel by completing another International Direct Deposit Enrollment/Authorization Form or I contact the CA SDU at 001-408-273-0073 or
. casdu-electronichelpdesk@dcss.ca.gov I understand that my participation in the direct deposit program can be cancelled at any time, if necessary, without
my written permission.
