Fillable Instructions for Employee Direct Deposit Form (Oregon)

Fill Online, Printable, Fillable, Blank Instructions for Employee Direct Deposit Form (Oregon) Form

Use Fill to complete blank online OREGON pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Instructions for Employee Direct Deposit Form (Oregon)

On average this form takes 7 minutes to complete

The Instructions for Employee Direct Deposit Form (Oregon) form is 2 pages long and contains:

  • 0 signatures
  • 19 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

BROWSE OREGON FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Instructions for Employee Direct Deposit Form
Allow at least fourteen (14) business days for a new direct deposit set‐up.
If you are signing up for the US Bank Focus® Card DO NOT USE THIS FORM. Use the Pay Card Authorization
form. OSPS.99.19
http://oregon.gov/DAS/Financial/Payroll/Documents/OSPS.99.19.pdf
Fill out this form completely and return to your Agency Payroll Office. Attach a void check for each checking account. If
depositing to a savings account or pre‐loaded bank card ask your bank to give you the Routing/Transit number for your
account, this number isn’t always the same as shown on the deposit slip. It is your responsibility to provide complete and
accurate account information.
•
Employee Oregon ID # ‐ This is your 9 digit employee number as assigned in the personnel system. This OR# can be
found on your pa
y statement or personnel action documents. Contact your agency payroll or human resource office
for assistance. DO NOT USE YOUR SOCIAL SECURITY NUMBER.
•
Email Address – the email address that you will use for your ePayroll account, a work or personal email address is
acceptable.
•
New – Select to add a brand new account for a fixed or net pay deposit.
•
Cancel * – Select to cancel an existing deposit. Please be sure to include the routing and account numbers on the form.
•
Replace* – Select to replace an existing or net pay account or to replace a fixed deposit account and/or amount.
•
Bank Name/City/State – The name of the financial institution you are depositing to and location of the branch where
you have your ac
count (if known).
•
Routing/Transit # ‐ The 9 digit ABA number found on your check (see example below). Contact your bank for
assistance.
•
Account # ‐ The account number where you wish to have the funds deposited.
•
Travel Reimbursements – Indicate this box only if you expect to travel for your agency and be reimbursed through
the accounting sy
stem (SFMA) (choose only ONE account).
•
Dep. Amount or Net amount – Fixed dollar amount or remainder of check (net amount selection required
for
participation in ePaystub program).
Onc
e a net pay deposit is established, you will receive your paystub electronically. (OAR. 125‐015‐0200 or applicable policy).
Paystubs can be accessed at: http://epayroll.oregon.gov.
*If you ar
e canceling your net pay direct deposit, you may receive a paper check and paper stub on your next scheduled
payday.
Electronic Deposit/ePaystub (OAR. 125‐015‐0200)
Employees choosing to use one of the exception criteria to receive direct deposit but not participate in ePaystub, will be
automatically enrolled in direct deposit and ePaystub until verification by payroll/human resources of the exception criteria is
completed. Employees are responsible for getting the proper verification for meeting the exception criteria from their agency
payroll or human resources staff.
DO NOT SUBMIT TO OSPS INSTRUCTIONS TO PAYROLL OFFICES
The completed form is Information Asset Classification Level 3 as defined by the Enterprise Security Office.
Refer to the Secretary of State, Archives Division Administrative Rules for retention guidelines.
State of Oregon Employee Direct Deposit Form
Employee ID # Agency #
Name
Email
Address
Work Phone #
Account
information: New Cancel Replace Net Pay Account Replace Fixed Account and/or Amount
1.
Bank Name/City/State:
Routing/Transit # Account #
Checking Savings
Non‐AccelaPay Card Travel Reimbursements Dep. Amt.: $
or
Net amount
Account information: New Cancel Replace Net Pay Account Replace Fixed Account and/or Amount
2.
Bank Name/City/State:
Routing/Transit # Account #
Checking Savings
Non‐AccelaPay Card Travel Reimbursements Dep. Amt.: $
or
Net amount
Employee Authorization ‐ Important! Read and sign before submitting
I aut
horize the State of Oregon to deposit payments and make overpayment adjusting debits to my account. I have read and
understand the information contained in this form. I understand that direct deposit transactions must comply with U.S. and Oregon
laws. I authorize the State of Oregon to suspend direct deposit participation when overpayments may occur or recur (Ref. OAM
45.37.00).
International transaction certification – I certify that the entire amount of my direct deposit is NOT ultimately deposited in a financial
institution outside the United States.
Electronic Deposit/ePaystub (OAR. 125‐015‐0200):
I have elected net pay direct deposit of my wages and agree to access my paystub electronically.
I elect not to participate in net pay direct deposit of my wages and will receive a paper check and paper stub.
I meet one of the exception criteria listed in Oregon Administrative Rule 125‐015‐0200 and am choosing to receive my pay
through direct deposit and not participate in ePaystub (this option requires payroll and/or *human resources authorization).
*HR verification:
Print Name Signature
Exception Code: _______________________________________ Date: ____________________________________
Employee Signature: Date:
FOR AGENCY USE:
Entry Date (P070) “X”
XDNN (plan code)
Date Pre‐note “P”
Date Verified “V”
Initials
ePaystub Enroll: Date: Initials:
SFMS
Approval:
Date:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Instructions for Employee Direct Deposit Form (Oregon)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 17 February 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document