Please rate Direct Deposit Los Angeles 12-2014
To sign up for Direct Deposit, the payee/vendor is to read the back of this form and fill in the information requested in Sections 1 and 2.
Checking account: attach a voided personal/business check and write “VOID” on the front of the check, or ask your Depository Institution to complete Section 2.
Savings or credit union: for a savings account, or any credit union account, a representative from your Depository Institution must complete Section 2.
Address: the County will reject applications if the address on the application does not match the printout.
Cancellation: to stop Direct Deposit, call your Eligibility Worker or Contract Manager and request a PA 1675-3, Direct Deposit Cancellation Form.
| Question | Answer |
|---|---|
| Form Name | PA 1675 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 41 |
| Avg. time to fill out | 7 min |
| Edition | Rev.12/2014 |
| Where to send | Use the envelope provided to you; if you did not receive an envelope to mail this form, return it to Los Angeles County Auditor-Controller, P.O. Box 7000, Downey, CA 90241-9907 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | PA 1675, PA1675, PA 167, Form PA 1675, DPSS Direct Deposit Form, Direct Deposit Authorization Sign-Up Form |
| Official source | PA 1675 (Rev 12/2014), County of Los Angeles Department of Public Social Services |
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Please rate Direct Deposit Los Angeles 12-2014
