Dss 4718 Form PDF Details

Facilitating a more streamlined process for child support payment reception, the DSS 4718 form plays a pivotal role within the North Carolina Child Support Enforcement Program. The essence of this document is to authorize direct deposits, offering a much-needed alternative to the conventional methods of payment delivery via debit card or check. Requiring completion in either blue or black ink, it emphasizes the importance of providing accurate and comprehensive information to avoid any delays in the processing of the request, which can take approximately 3 to 4 weeks to effectuate. The form uniquely caters to different needs by allowing individuals to start, change, or cease direct deposit services to a specified checking or savings account. It mandates the attachment of a voided, preprinted check for those opting for a checking account or necessitates bank completion for savings accounts. Notably, the inclusion of bank details and the necessity for an account holder’s authorization underscore the rigorous approach towards mitigating errors and safeguarding the direct deposit process. Additionally, it delineates the steps for those desiring to halt direct deposit services, merely requiring a signature under the specific request. The DSS 4718 form, by virtue of its design and requirements, signifies a systematic effort to enhance the efficiency, security, and convenience of receiving child support payments in North Carolina.

QuestionAnswer
Form NameDss 4718 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnc child support direct deposit, 2009, DSS-4718, EFT

Form Preview Example

N o r t h Ca r o li n a Ch i l d S u p p o r t En fo r c e m e n t P r o g r a m

DIRECT DEPOSIT AUTHORIZATION

PLEASE COMPLETE IN BLUE OR BLACK INK. INCOMPLETE OR INCORRECT INFORMATION MAY RESULT

IN A DELAY IN PROCESSING THIS REQUEST. ALLOW 3 TO 4 WEEKS FOR DIRECT DEPOSIT TO TAKE EFFECT.

Until this request is processed, payments will be made by debit card or check.

NAME: __________________________________ _____________________________________

_____

(LAST)

(FIRST)

(MI)

SOCIAL SECURITY NUMBER______________________________

MPI #______________________

ADDRESS: __________________________________________ HOME PHONE # (____)__________

(STREET/POB)

________________________________________________________ WORK PHONE # (____)_________

(CITY)

(STATE)

(ZIP CODE)

1.CHECK THE TYPE OF REQUEST BELOW:

____ START/CHANGE DIRECT DEPOSIT – CHECK TYPE OF ACCOUNT AND PROVIDE DOCUMENTATION.

____ CHECKING ACCT – ATTACH A VOIDED PREPRINTED CHECK TO THIS FORM (NO STARTER CHECKS); OR

HAVE THE BANK COMPLETE THE INFORMATION IN #2 BELOW. READ AND SIGN #3 BELOW.

____ SAVINGS ACCT – THE BANK MUST COMPLETE #2 BELOW. READ AND SIGN #3 BELOW.

____ STOP DIRECT DEPOSIT – DO NOT ATTACH A CHECK. PLEASE SIGN # 3 BELOW.

2.BANK INFORMATION – THE BANK MUST COMPLETE THIS SECTION FOR A SAVINGS ACCOUNT OR IF YOU DO NOT HAVE A PREPRINTED CHECK.

BANK NAME___________________________________________________ BANK PHONE # ____________________

BANK ADDRESS_________________________________________________________________________________

BANK ROUTING NUMBER ____ ____ ____ ____ ____ ____ ____ ____ ____

BANK ACCOUNT NUMBER ________________________________________

BANK REPRESENTATIVE’S NAME (PRINTED) ___________________________________________________________

BANK REPRESENTATIVE’S SIGNATURE_________________________________________ Date ___/____/_______

3.AUTHORIZATION AND SIGNATURE. PLEASE READ, SIGN AND DATE. PLEASE DO NOT SEND CORRESPONDENCE WITH THIS DOCUMENT.

I hereby authorize the NC Child Support Enforcement program (CSE) to deposit my child support payments to the financial institution account named above. CSE will make deposits to this bank account until I cancel the authorization and CSE has time to process the cancellation. I authorize CSE to contact the financial institution and make debit entries and adjustments for any credit entries made in error to my account. I understand that until this request is processed, payments will be made by debit card or check.

YOUR SIGNATURE: __________________________________________ DATE:______/______/_______

MAIL SIGNED ORIGINAL COMPLETED FORM TO:

NCCSE –EFT

PO BOX 19807

Raleigh, North Carolina 27619

If you have questions or address changes, call 1-800-992-9457.

DSS-4718 Rev 08/2009

For Office Use Only: Date of Receipt____________________

How to Edit Dss 4718 Form Online for Free

Whenever you need to fill out Raleigh, there's no need to install any kind of software - just try our PDF tool. Our editor is consistently evolving to give the best user experience attainable, and that's due to our resolve for continual enhancement and listening closely to testimonials. In case you are seeking to begin, this is what you will need to do:

Step 1: Click on the "Get Form" button above on this page to get into our PDF tool.

Step 2: The editor helps you work with PDF documents in various ways. Change it by adding any text, adjust original content, and put in a signature - all manageable in minutes!

This document will need specific info to be typed in, thus make sure to take some time to enter what's required:

1. First of all, when filling in the Raleigh, beging with the area that features the next blank fields:

Filling in segment 1 in PREPRINTED

2. Soon after filling out the last part, go on to the next step and fill in all required details in all these blanks - NAME MI SOCIAL SECURITY NUMBER, BANK NAME BANK PHONE, BANK ADDRESS, BANK ROUTING NUMBER, BANK ACCOUNT NUMBER, BANK REPRESENTATIVES NAME PRINTED, BANK REPRESENTATIVES SIGNATURE, AUTHORIZATION AND SIGNATURE, DOCUMENT, and I hereby authorize the NC Child.

BANK ROUTING NUMBER, I hereby authorize the NC Child, and DOCUMENT inside PREPRINTED

It's easy to make a mistake while filling in your BANK ROUTING NUMBER, hence make sure that you go through it again before you send it in.

Step 3: After you've looked once again at the details you filled in, press "Done" to complete your FormsPal process. Right after starting a7-day free trial account with us, you will be able to download Raleigh or send it via email directly. The form will also be available via your personal cabinet with your every change. FormsPal offers risk-free document tools devoid of data recording or distributing. Feel at ease knowing that your details are in good hands here!

Dss 4718 Form isn’t the one you’re looking for?

Related Documents