Dss 4718 Form PDF Details

Dss 4718 form is the document used to apply for cash assistance in the state of California. This form is also used to determine eligibility for benefits and calculate benefit amounts. In order to apply for cash assistance, you must first meet certain eligibility requirements. The Dss 4718 form can be downloaded and filled out online, or you can pick up a copy at your local Department of Social Services office. The Dss 4718 form can be a little daunting, but don't worry - we're here to help! In this blog post, we will go over each section of the form and provide explanations and examples. We'll also tell you what to do if you have any questions or problems filling out the form. So let's get started!

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

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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.

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