Fillable State of Oklahoma Office of Personnel Management (Northeastern Oklahoma A&M College)

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State of Oklahoma Office of Personnel Management (Northeastern Oklahoma A&M College)

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OPM-73 (1/18/06)
Official Use Only
State of Oklahoma
Office of Personnel Management
AUTOMATIC DEPOSIT TRANSMITTAL
This form is to be used by State and Higher Education Employees in communicating their direct deposit information.
PS Employee ID:
Social Security
Number:
First Name
(limit to 15 characters)
Last Name
(limit to 15 characters):
Date of Birth:
/ /
MM DD YYYY
I hereby authorize the State of Oklahoma, as per the Oklahoma State Employee’s Direct Deposit Act, 74:292.10 to:
A
DD
PAYROLL – (Deposit my payroll warrant in my account as indicated below)
REMOVE
PAYROLL – (I understand that by terminating Direct Deposit for Payroll this will automatically terminate travel and
spending from my direct deposit)
A
DD/ REMOVE
SPENDING ACCOUNT – (HEALTH CARE, DEPENDENT CARE REIMBURSEMENT)
A
DD/ REMOVE
TRAVEL
If monies to which I am not entitled are deposited to my account, I authorize the State of Oklahoma to direct the financial institution to
return said funds. I understand the payroll date and frequency of payment currently being utilized by my employing agency will not be
affected by my decision to use Electronic Fund Transfer.
ONLY ONE ACCOUNT MAY BE USED FOR DIRECT DEPOSIT
CHECKING
SAVINGS
PayCard
Financial Institution
Name (Your Bank):
City:
State:
This authority is to remain in full force and effect until: (A) I give my employer written notice using this form (OPM-73) to terminate this
direct deposit agreement. (B) I fail to utilize payroll direct deposit for 365 days, at which time this agreement will expire. (C) The event of
my death, at which time this agreement expires immediately, upon notification. This information is provided by me to facilitate my
personal banking needs and shall be considered personal and held in confidence
.
Home Mailing
Address:
City:
State:
ZIP:
Home Telephone
Number:
Work Telephone
Number:
Email:
Employing Agency:
Signature:
Date:
/ /
I understand that while a change of enrollment is in process I may, in fact, receive a warrant instead of an electronic transfer.
If this is an initial enrollment or bank routing and/or account number change please attach a voided check or an official document from
your financial institution showing the financial institution’s routing number and your account number.
A signed form must be on file with the employer.
Please mail the completed form to the address below.
ATTENTION: Employing Organization
Direct Deposit Contact
Paycard Option:
Customer Service Phone Number: 1-888-913-0900
ATTACH CHECK HERE
OPM-73 (1/18/06)
AUTOMATIC DEPOSIT AUTHORIZATION INSTRUCTIONS
Do not fill out or submit this form for change of Address or Name change.
1. Social Security Number
Enter employee social security number.
2. Name
Type or print employee name exactly as it appears on your account.
3. Type of Account
Indicate whether your account is a checking or savings account or paycard. If
paycard is selected see number 9.
4. Financial Institution Name Enter the name of the bank, savings and loan or credit union where your account is
held, i.e.: Bank-One.
5. Financial Institution, City, State
Enter the city and state of your financial institution.
6. Employing Agency
Enter the name of the state agency you work for.
7. Signature and Date Sign and date the request form. NOTE-A request form cannot be processed
without your signature as authorization.
8. Voided Check For deposit to a checking account, attach to this request a VOIDED
check from the
financial institution of your choice so that we can use the information to make a
proper deposit. For a deposit to a savings account, provide a document from your
financial institution showing the financial institution’s routing number and your
account number. NOTE-A request form cannot be processed without this
information. Thank you.
9. Paycard If paycard is selected, place the following information in the Financial Institution
box: First Financial Bank ABA 084 003 997
WHAT HAPPENS NEXT
When your payroll, spending, and/or travel reimbursement is included in the Direct Deposit system, or the Paycard you
will receive a Notice of Deposit instead of a warrant. The pay stub will not change, you will continue to receive a record of
your earnings.
If you should have any problems, follow the procedures listed below:
1. Call your bank and ask for Commercial Direct Deposit Assistance. Advise them that you are on direct deposit through
“ACH” (Automated Clearing House). If you still have problems, ask to speak to an Officer of the Bank, a Teller
Supervisor or a Customer Service Representative. Write down the names of the people you talk to and the phone
number you called.
2. For Payroll Deposits
If you are not satisfied with the results for pay warrants, contact the payroll office of your employer, Direct Deposit
Unit. You must have completed Step 1 before calling the Direct Deposit Unit. We will need the Phone Numbers and
Names of the people you talked with at your bank.
3. For Travel Deposits
If you are not satisfied with the results for travel warrants, contact your agency representative(s) who processes your
travel claims.
4. For Spending Account Deposits
If you are not satisfied with the results for spending account warrants, contact Spending Accounts Administration at
the Employees Benefit Council (405) 232-1190.
5. For Paycard Deposits
Contact MoneyNetwork Customer Service – 1-800-913-0900 or www.moneynetwork.com
. Then follow the procedures
in Step 1.
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State of Oklahoma Office of Personnel Management (Northeastern Oklahoma A&M College)

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Completed 26 July 2020

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