Fillable PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS (West Virginia Northern Community College)

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PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS (West Virginia Northern Community College)

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The PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS (West Virginia Northern Community College) form is 3 pages long and contains:

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  • 47 other fields

Country of origin: US
File type: PDF

U.S.A. forms for West Virginia Northern Community College

BROWSE WEST VIRGINIA NORTHERN COMMUNITY COLLEGE FORMS

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1. List the Financial Institution Name. Your net pay will be going to the Financial Institution Name
listed.
2. Indicate whether the account is checking or savings. Mark one box ONLY!
a. Checking
Attach a voided check, Financial Institution statement, or a letter from the Financial
Institution (on FI letterhead) listing the account information, printed name, and
signature of the Financial Institution representative, title and contact information.
b. Savings
Attach a Financial Institution statement or letter from the Financial Institution
(on FI letterhead) listing the account information, printed name, and signature of the
Financial Institution representative, title and contact information.
3. Indicate by marking the appropriate box. Mark one box ONLY!
a. Start Direct Deposit
Net pay is currently not setup for direct deposit.
b. Change
Net pay is currently setup for direct deposit and you want to send your net pay to a
different account or Financial Institution. Do not close your old account until you have
received a payment in the new account. This will help prevent a delay in receiving
your pay.
c. No Change
Continuing with the current direct deposit for your net pay. Mark this box only
if you are requesting an add, change or cancel to a secondary account.
Payroll Primary Account
PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS
In order to process a Payroll Direct Deposit request the employee must do the following:
1. Provide First and Last Name
2. Provide EPICS Employee Number - (Can be provided by your payroll department.)
3. Provide Social Security Number
4. Complete, Sign, and Date the form.
5. Deliver the form with your account documentation to your State Agency Payroll Department for completion.
Payroll Secondary Account(s)
1. List the Financial Institution Name. Your secondary account will be going to the Financial
Institution Name listed.
2. Indicate whether the account is checking or savings. Mark one box ONLY!
a. Checking
Attach a voided check, Financial Institution statement, or a letter from the Financial Institution
(on FI letterhead) listing the account information, printed name, and signature of the
Financial Institution representative, title and contact information.
b. Saving
Attach a Financial Institution statement or letter from the Financial Institution
(on FI letterhead) listing the account information, printed name, and signature
of the Financial Institution representative, title and contact information.
3. Indicate by marking the appropriate box. Mark one box ONLY!
a. Start Direct Deposit
A secondary account that is currently not setup for direct deposit.
b. Change
A secondary account is currently setup for direct deposit and you want to send your
set amount to a different account, Financial Institution, or wish to change your set amount.
Do not close your old account until you have received a payment in the new account.
This will help prevent a delay in receiving your pay.
c. Cancel
No longer want your secondary account(s) direct deposited.
d. No Change
Continuing with the current direct deposit for your secondary account(s). Mark
this box only if you are requesting an add, change, or cancel of the Primary Account and/or requesting an
add, change or cancel to another secondary account.
4. The dollar amount must be the same for each pay period.
5. More than two secondary accounts will require an additional form to be completed and
signed.
To complete the employee's Payroll Direct Deposit request, the State Agency Payroll Department must do the
following:
1. Provide the State Agency Name.
2. Provide a Phone Number.
3. Sign and Date the form.
4. Review the form and make sure it has been completed.
5. Forward the form along with the documentation to the WVSAO, ePayments Division.
PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS
Payroll Secondary Account(s) - Continued
Last Name: MI: First Name:
Payroll Direct Deposit Form
West Virginia State Auditor's Office, ePayments Division - 1900 Kanawha Blvd., E., Bldg. 1, Room W-121, Charleston, WV 25305
Telephone: 1-800-500-4079 Fax: (304) 340-5084 www.wvsao.gov
______
SSN:
EPICS #:
Routing #:
Account #:
Saving
Checking - Attach a voided check.
No ChangeChangeStart Direct Deposit
Bank Name:
PAYROLL PRIMARY ACCOUNT:
Saving
.
Dollar Amount:
Account #:
Checking - Attach a voided check.
Routing #:
No ChangeCancelChange Start Direct Deposit
Bank Name:
PAYROLL SECONDARY ACCOUNT(S): If you have more than two secondary accounts, please complete an additional form.
Routing #:
Account #:
Bank Name:
Cancel No ChangeChange Start Direct Deposit
.
Dollar Amount:
Saving
Checking - Attach a voided check.
I hereby authorize the State of West Virginia, hereinafter called STATE, to initiate credit entries to the account(s) as indicated
above and to initiate debit entries as adjustments for credit entries made in error. 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 form. This authority is to
remain in full force and effect until I have filed a new payroll form in a timely manner so as to afford the STATE a reasonable
opportunity to act
. I further acknowledge that my employee pay stub will be made available to me through a secure internet
web site.
Date:
Employee's Signature:
To be completed by the State Agency Payroll Department.
Date:
Payroll Representative's Signature:
I hereby certify I am a payroll representative of the herein named State Agency and that being so authorized I do certify the
information listed and attached with this authorization has been received from the employee indicated above.
State Agency:
Pursuant to Section 7 of the Privacy Act of 1974, the disclosure of your Social Security Number is mandatory. Social Security Numbers are necessary to properly maintain records concerning your
direct deposit payments as is required and authorized by the federal government for tax administration purposes. See generally, 42 U.S.C. § 405(c). Failure to provide a Social
Security Number will
prevent us from processing your direct deposit request.
- PLEASE FORWARD TO YOUR STATE AGENCY PAYROLL DEPARTMENT ONCE COMPLETED -
Phone #:
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PAYROLL DIRECT DEPOSIT FORM INSTRUCTIONS (West Virginia Northern Community College)

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Completed 27 July 2020

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