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The Direct Deposit Los Angeles form is a crucial document for individuals receiving public assistance benefits from the Department of Public Social Services (DPSS). This form simplifies the process of receiving cash benefits by allowing payments to be deposited directly into a bank account of the payee's choice. To get started, payees need to provide essential information in two sections: personal details and banking information. Section 1 requires the payee's name, case number, and social security number, along with the type of account—checking or savings. In Section 2, the depository institution must confirm the account details, including the routing and account numbers. This form also emphasizes the importance of keeping information up-to-date, as any changes to the account must be communicated to DPSS to avoid delays in benefit payments. Additionally, it outlines the responsibilities of both the payee and the depository institution regarding the handling of funds. Understanding the requirements and processes involved in completing this form ensures a smoother experience for those relying on public assistance in Los Angeles.

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DIRECT DEPOSIT AUTHORIZATION SIGN-UP FORM - PARTICIPANTS

Department of Public Social Services

To sign up for direct deposit, the payee is to read the back of this form and fill in the information requested in Sections 1 and 2 to convert your case to direct deposit. Please print and fill this form out completely.

SECTION 1 (To be completed by the Payee - Please Print)

Payee Name: (Last, First, Middle) )

Case Number: (LDRP+Case Number+Payee ID)

 

LDRP ___ ___ ___ ___ ___ ___ ___

___ ___

 

(Case Number)

 

(Payee ID*)

Case Name: (if different than payee)

Type of account: (circle one)

 

 

 

Checking

Savings

 

 

 

Address:

Payee’s Social Security Number/Taxpayer ID#:

City, State and ZIP Code:

Telephone Number:

Payee Certification

This authorizes and instructs the Department of Public Social Services (DPSS) to deposit cash benefits to which I am entitled directly into the account at the depository institution designated in Section 2 below. I understand that DPSS’ obligation is limited to the direct deposit of public assistance payments. DPSS is not responsible for withdrawals from the account, including garnishments, after benefits are deposited. I understand that this authorization is to remain in full force and effect until DPSS has received notice as specified below of any change to these instructions. I agree to immediately notify DPSS in writing if I am removed from the account or it is closed for any reason. I understand that if my account is closed without providing DPSS at least five business days written notice, my cash benefits may be delayed. I agree to give DPSS five (5) business days written notice of withdrawal of my authorization or other change to these instructions.

Signature: ____________________________________________

Date: _______________________

Payee

SECTION 2 (To be completed by Depository Institution) – (Bank, Credit Union, etc.)

 

Name of Depository Institution:

Depositor’s name on account: (list all account

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

holders)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of Depository Institution:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Account Holder’s Primary/Secondary Social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security Number/s:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Routing Number:

Account Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Depository Institution Certification

I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named depository institution, I certify that the depository institution agrees to receive and deposit payments from the County of Los Angeles.

Representative’s Name: __________________________________________________

Telephone:___________________________

Representative’s Signature: ________________________________________________

Date: ______________________________

 

 

 

 

 

 

COUNTY USE ONLY

 

 

DPSS Staff

Auditor-Controller Staff for eCAPS Entry

Attach the following LEADER

DEPARTMENT CODE: SS

BUSINESS TYPE: LDRP CERTIFICATION NO.: 7 Digit Case #

VENDOR/CUSTOMER CODE: Use full 13 Digit Case Number from “SECTION 1”

Screen Prints:

 

[LDRP+Case Number+Payee ID]

1.

Case Profile

 

ORG TYPE: Individual

ORG CLASS: Individual

2.

Case Payee *

ADDRESS TYPE: Payment

ADDRESS ID: 001

* Payee ID found on Case Payee screen

EFT FORMAT: PPD1

EFT STATUS: Prenote Requested

 

 

PA 1675 (Rev: 6/05) Participants

PLEASE READ THIS CAREFULLY

The information provided on this form will remain confidential and be kept by the Department of the Auditor- Controller on behalf of Los Angeles County. Failure to provide the requested information may affect the processing of this form and may delay or prevent the receipt of benefits through the Direct Deposit Program.

Return this form with the computer screen printouts attached by your Eligibility Worker to the Auditor-Controller using the envelope provided to you. If you did not receive an envelope to mail this form please return this form to:

Los Angeles County Auditor-Controller

P.O. Box 7000

Downey, CA 90241-9907

Instructions For Completing This Form

Print clearly and complete Section 1 of this form.

Write the payee name exactly as it appears on the printout.

Make sure the address on the printout provided by your Eligibility Worker is your current address. The County will reject applications if the address on the application does not match the printout.

Write your Case Number and Payee ID exactly as it appears on the printout.

If you want your cash benefits deposited into your checking account, attach a voided personal check to this form, and write, “VOID” on the front of the check OR ask your depository institution to complete Section 2. If you want your cash benefits to be deposited into your savings account, or into any credit union account, (checking or savings) a representative from your depository institution MUST complete Section 2.

If the address on your personal check is different from your current address, cross out your old address and print your new address on your personal check. The address printed or handwritten on your check must match your application and the printout provided by your Eligibility Worker.

Cancellation

Direct deposit will remain in effect until cancelled by either yourself or DPSS. To stop direct deposit, call your Eligibility Worker and request a PA 1675-3, Cancellation for Direct Deposit Form. If you or your depository institution closes your bank account, you must report the account closure to avoid delays in receiving your benefits.

Changing Depository Institutions

To change depository institutions for direct deposit, you must complete a Cancellation for Direct Deposit Form and a new Direct Deposit Sign-Up Form. Return all forms with computer screen printouts attached by your Eligibility Worker to the Auditor-Controller using the envelope provided to you. If you did not receive an envelope to mail the forms, please return them to:

Los Angeles County Auditor-Controller

P.O. Box 7000

Downey, CA 90241-9907

It is recommended that you maintain accounts at both depository institutions until the new depository institution receives the first direct deposit.

PA 1675 (Rev: 6/05) Participants

Document Specifics

Fact Name Description
Purpose The Direct Deposit Authorization Sign-Up Form allows participants to authorize the Department of Public Social Services (DPSS) to deposit cash benefits directly into their bank accounts.
Sections The form consists of two main sections: Section 1 for the payee's information and Section 2 for the depository institution's details.
Confidentiality Information provided on the form is confidential and will be kept by the Department of the Auditor-Controller on behalf of Los Angeles County.
Governing Law This form is governed by California state laws regarding public assistance and direct deposit regulations.
Cancellation Policy Direct deposit remains in effect until canceled by the participant or DPSS. Participants must notify their eligibility worker to stop direct deposit.

Direct Deposit Los Angeles: Usage Instruction

Filling out the Direct Deposit Los Angeles form is a straightforward process that ensures your benefits are deposited directly into your bank account. After completing the form, you will need to submit it along with any necessary documentation to ensure a smooth transition to direct deposit.

  1. Obtain the form: Get the Direct Deposit Authorization Sign-Up Form from your Eligibility Worker or download it online.
  2. Section 1 - Payee Information: In this section, print your name as it appears on the printout. Include your case number and payee ID exactly as shown.
  3. Account Type: Circle whether you want your benefits deposited into a checking or savings account.
  4. Provide your address: Ensure that the address matches the one on your printout. This is crucial for processing.
  5. Social Security Number: Fill in your Social Security Number or Taxpayer ID.
  6. Contact Information: Enter your telephone number for any follow-up questions.
  7. Certification: Read the certification statement carefully, then sign and date the form at the bottom of Section 1.
  8. Section 2 - Depository Institution Information: Provide the name of your bank or credit union, and the account holder's name(s) as they appear on the account.
  9. Institution Address: Fill in the address of your bank or credit union.
  10. Account Details: Provide the routing number and account number for your bank account.
  11. Institution Certification: A representative from your bank or credit union must sign and date this section, confirming your identity and account details.
  12. Submission: Return the completed form along with any required documentation to your Eligibility Worker, or mail it to the Los Angeles County Auditor-Controller if needed.

Learn More on Direct Deposit Los Angeles

What is the Direct Deposit Los Angeles form?

The Direct Deposit Los Angeles form is an authorization document that allows recipients of public assistance benefits to have their payments deposited directly into their bank accounts. This process simplifies the receipt of benefits and ensures timely payments.

Who needs to complete this form?

Individuals who receive public assistance benefits from the Department of Public Social Services (DPSS) in Los Angeles must complete this form to enroll in the direct deposit program. This includes payees who want their cash benefits deposited directly into their checking or savings accounts.

What information is required to fill out the form?

The form requires several pieces of information:

  • Payee's name, case number, and case name (if different from the payee).
  • Type of account (checking or savings).
  • Payee's Social Security number or Taxpayer ID.
  • Contact information, including address and telephone number.
  • Details about the depository institution, such as the bank name, account number, and routing number.

All information must be printed clearly and accurately to avoid processing delays.

How do I submit the completed form?

After completing the form, it should be returned to the DPSS. If an envelope was provided by your Eligibility Worker, use that to send the form. If not, mail it to:

Los Angeles County Auditor-Controller
P.O. Box 7000
Downey, CA 90241-9907

What happens if I change my bank account?

If you need to change your bank account, you must first complete a Cancellation for Direct Deposit Form. Then, fill out a new Direct Deposit Sign-Up Form. It is important to keep both accounts active until the new account receives the first direct deposit to prevent any interruptions in your benefits.

Can I cancel my direct deposit?

Yes, you can cancel your direct deposit at any time. To do this, you must contact your Eligibility Worker and request a PA 1675-3 Cancellation for Direct Deposit Form. Once the cancellation is processed, your benefits will no longer be deposited directly into your account.

What should I do if my account is closed?

If your bank account is closed, it is crucial to notify DPSS immediately. Failing to do so can lead to delays in receiving your benefits. You should provide written notice at least five business days before the account closure to avoid any disruption in your payments.

Is my information kept confidential?

Yes, the information provided on the Direct Deposit Los Angeles form is kept confidential. The Department of the Auditor-Controller safeguards your personal details and ensures that they are used only for the purpose of processing your direct deposit requests.

Common mistakes

Filling out the Direct Deposit Los Angeles form can be straightforward, but many individuals make common mistakes that can lead to delays or complications in receiving their benefits. One frequent error is failing to provide accurate personal information. The payee's name, case number, and payee ID must match exactly with the information on the printout provided by the Eligibility Worker. Any discrepancies may result in rejection of the application.

Another mistake often seen is not updating the address. The form requires the current address to be clearly printed. If the address on the application does not match the one on the printout, the County may reject the application. This can cause significant delays in receiving benefits, which can be particularly problematic for those relying on timely assistance.

Many applicants also overlook the requirement for bank information. If the payee wishes to have benefits deposited into a checking account, they must attach a voided personal check. Alternatively, if opting for a savings account or credit union account, a representative from the depository institution must complete Section 2 of the form. Failing to provide the correct documentation can lead to processing delays.

People often forget to include their Social Security Number or Taxpayer ID. This information is crucial for the Department of Public Social Services to process the direct deposit. Without it, the application may be incomplete, causing further delays in benefits being issued.

Another common oversight involves the certification section. The payee must sign and date the form to authorize the direct deposit. Neglecting to provide a signature or date can halt the entire process, leaving the applicant without access to their benefits.

Lastly, individuals sometimes fail to notify DPSS of any changes. If an account is closed or the payee is removed from the account, immediate written notification is required. Not doing so can lead to delays in benefit deposits and potential issues with accessing funds. Maintaining clear communication with the Department is essential for ensuring uninterrupted service.

Documents used along the form

When signing up for direct deposit through the Direct Deposit Los Angeles form, several additional documents may be required to ensure a smooth process. Each of these documents plays a crucial role in confirming identity, authorizing transactions, or managing account changes. Below is a list of commonly used forms that accompany the Direct Deposit Los Angeles form.

  • Voided Check: A voided check is often required when setting up direct deposit into a checking account. This document verifies the account number and routing number, ensuring that funds are deposited correctly. It must have the word "VOID" written across it to prevent any unauthorized use.
  • Cancellation for Direct Deposit Form: This form is necessary when a payee wishes to cancel their direct deposit. It formally notifies the Department of Public Social Services (DPSS) of the intent to stop the direct deposit process, preventing any future deposits from being made to the account.
  • Computer Screen Printouts: These printouts provide essential information regarding the payee's case number and personal details. They are required to ensure that the information on the Direct Deposit form matches the records held by the DPSS.
  • Account Change Form: If a payee wishes to change their depository institution, this form must be completed. It allows the payee to officially notify the DPSS of the new banking details, ensuring that future deposits are directed to the correct account.

Understanding these additional documents can facilitate a more efficient direct deposit setup. Each form serves a specific purpose, contributing to the overall accuracy and reliability of the payment process. Properly completing and submitting these forms will help ensure timely access to benefits.

Similar forms

The Direct Deposit Authorization Form is similar to the W-4 Form, which is used for tax withholding purposes. Both documents require personal information, such as name and Social Security number. The W-4 allows employees to specify how much federal income tax should be withheld from their paychecks, while the Direct Deposit Form instructs where benefits should be deposited. Each form ensures that the correct financial information is provided to facilitate timely payments, whether for wages or public assistance benefits.

Another similar document is the ACH Authorization Form. Like the Direct Deposit Form, the ACH Authorization Form is used to set up automatic electronic payments. Both forms require details about the bank account, including the account number and routing number. The ACH Authorization Form is often used for recurring payments like utility bills, while the Direct Deposit Form is specifically for receiving benefits. Both documents aim to streamline the payment process and ensure funds are transferred accurately.

The Direct Deposit Form also resembles the Payroll Deduction Authorization Form. This form allows employees to authorize deductions from their paychecks for various purposes, such as retirement contributions or health insurance premiums. Similar to the Direct Deposit Form, it requires personal information and the designation of accounts. Both forms help manage financial transactions efficiently, ensuring that funds are directed to the correct accounts without delays.

Lastly, the Bank Account Verification Form shares similarities with the Direct Deposit Form. This document is used to confirm account details with a bank, ensuring that the information provided is accurate. Both forms require bank account information, including the account holder's name and account number. While the Direct Deposit Form is focused on receiving funds, the Bank Account Verification Form is often used to validate account details for various transactions, providing a layer of security in financial dealings.

Dos and Don'ts

When filling out the Direct Deposit Los Angeles form, it is essential to follow specific guidelines to ensure the process goes smoothly. Below is a list of things to do and avoid.

  • Do print clearly and fill out all required sections completely.
  • Do use the payee name exactly as it appears on the printout provided by your Eligibility Worker.
  • Do ensure that the address on the application matches the address on the printout.
  • Do attach a voided personal check if you are choosing to deposit into a checking account.
  • Do notify DPSS in writing if your account is closed or if you are removed from the account.
  • Don't leave any sections of the form blank; incomplete forms may delay processing.
  • Don't provide an address on your personal check that differs from your current address.
  • Don't forget to give DPSS five business days' notice for any changes to your authorization.

Adhering to these guidelines can help prevent delays in receiving benefits through the Direct Deposit Program.

Misconceptions

Understanding the Direct Deposit Los Angeles form is essential for anyone looking to receive their benefits efficiently. However, several misconceptions can lead to confusion. Here are some common misunderstandings:

  • Direct deposit is mandatory for all benefits. Many people think they must use direct deposit. In reality, it is an option, not a requirement.
  • Filling out the form incorrectly won't matter. Some believe that minor errors are acceptable. However, inaccuracies can delay processing and benefits.
  • Once signed up, direct deposit cannot be changed. This is false. You can change your deposit details by submitting a new form.
  • The county is responsible for any issues with my bank account. This is a misconception. The county only deposits funds; it is not liable for any withdrawals or issues that occur afterward.
  • My information will not be kept confidential. Many worry about privacy. However, the information on the form is kept confidential by the Department of the Auditor-Controller.
  • I don't need to notify the county if I close my account. This is incorrect. Failing to notify the county can result in delays in receiving benefits.
  • I can use any bank account for direct deposit. While you can choose between checking and savings accounts, the bank must be a recognized depository institution.

By clarifying these misconceptions, individuals can navigate the Direct Deposit Los Angeles form more effectively and ensure they receive their benefits without unnecessary delays.

Key takeaways

When it comes to setting up direct deposit for your benefits in Los Angeles, understanding the process is crucial. Here are some key takeaways to help you navigate the Direct Deposit Authorization Sign-Up Form effectively:

  • Complete Information is Essential: Ensure that all sections of the form are filled out accurately. Missing or incorrect information can lead to delays in processing your direct deposit.
  • Verify Your Details: Double-check that your name, case number, and address match exactly with the printout provided by your Eligibility Worker. Discrepancies can result in rejection of your application.
  • Choose the Right Account: Clearly indicate whether you want your benefits deposited into a checking or savings account. If using a checking account, attach a voided check, or have your bank complete the necessary section.
  • Notify of Changes Promptly: If your account is closed or you change banks, inform the Department of Public Social Services (DPSS) immediately to avoid any disruption in receiving your benefits.
  • Understand Your Rights: You have the right to cancel your direct deposit at any time. To do so, request a Cancellation for Direct Deposit Form from your Eligibility Worker.
  • Maintain Both Accounts Temporarily: If you switch banks, keep your old account open until you confirm that the new bank has successfully received your first direct deposit.

By following these guidelines, you can ensure a smooth transition to direct deposit and minimize any potential issues with your benefits. Always keep a copy of your completed form and any correspondence with the DPSS for your records.