Per Capita Ho Chunk Form PDF Details

Ensuring the efficient and secure distribution of Per Capita payments to its members, the Ho-Chunk Nation Department of Treasury provides a Per Capita Direct Deposit Authorization Form. This document streamlines the process by which tribal members can have these funds directly deposited into their designated bank accounts, whether checking or savings. The form mandates the completion of specific steps, such as marking the type of account, filling in personal and financial institution details, and attaching a voided check to verify account information accurately. Importance is placed on the requirement for a signature to process the form, along with a stipulation that any changes to bank information must be communicated in writing. Additionally, it outlines the procedure for making changes or cancellations to the direct deposit authorization, including the necessity for such requests to be written and the timeline for processing, to ensure members experience no delay in receiving their distributions. The document emphasizes that for address changes, members must contact the Enrollment Office directly, as the Department of Treasury does not handle these updates. This form represents a critical tool for both the Ho-Chunk Nation and its members in managing the distribution of Per Capita payments efficiently and securely, highlighting the Nation's commitment to leveraging structured processes to better serve its community.

QuestionAnswer
Form NamePer Capita Ho Chunk Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdirect deposit form ho print, ho chunk treeasury direct deposit form, ho chunk nation treasury forms, ho chunk nation website

Form Preview Example

HO-CHUNK NATION

DEPARTMENT OF TREASURY

PER CAPITA DIRECT DEPOSIT

AUTHORIZATION FORM

Instructions:

1.Mark the box to indicate whether you want your check to be deposited into a savings or checking account.

2.Fill in the Tribal Member’s information and the Financial Institution boxes below.

3.Attach a voided check to ensure accurate account and routing number information. If you are unable to attach a voided check, contact or take this form to your financial institution for assistance with your account & routing numbers.

4.You must sign and date the form in order to have it processed.

5.You must notify Treasury in writing of any changes to your bank account information

MEMBER AUTHORIZATION—Please fill out completely and mail or fax to:

Ho-Chunk Nation, Department of Treasury

 

 

P.O. Box 640

OR

Fax (715) 284-9972

Black River Falls, WI 54615

 

 

I authorize the Department of Treasury and the Financial Institution listed below to initiate electronic credit entries, and if necessary, debit entries and adjustments for any credit entries in error to my:

Checking Account

Savings Account

TRIBAL MEMBER’S INFORMATION

NAME (PLEASE PRINT)

TRIBAL ID NUMBER

SOCIAL SECURITY NUMBER

YOUR ADDRESS

CITY, STATE, ZIP

PHONE NUMBER

FINANCIAL INSTITUTION INFORMATION

NAME

ADDRESS

CITY, STATE, ZIP

PHONE NUMBER

ACCOUNT NUMBER

ROUTING NUMBER -- must be nine digits!!

This authorization will remain in effect until cancelled in writing.

TRIBAL MEMBER’S SIGNATURE

DATE

P. O. Box 640 ~ Black River Falls, WI 54615

(715) 284.1660 ~ (800) 779.2873 ~ (715) 284.9972 FAX

Per Capita Direct Deposit Authorization Form

Page 2

The following is a brief explanation of the Per Capita Direct Deposit Authorization Form and process. If you have a specific question, not mentioned here, please be sure to contact the Department of Treasury.

•Changes (Additions/Deletions) will be done by the middle of the month prior to Per Capita Distribution.

•Any Per Capita Direct Deposit forms received after the deadline will be processed for the next per capita disbursement.

•All changes/cancellations must be in writing. This would include, but not be limited to the following:

OChange Name

OChange from Checking Account to Savings Account

OCancellation of Direct Deposit

•You can fax or mail an updated form for changes or a written cancellation request to the Department of Treasury.

•Per Capita Advances will be disbursement in the same manner that the Tribal member receives their quarterly Per Cap distributions (Manual Checks or Direct Deposit).

If the Department of Treasury receives an error report that your account has been closed, you will automatically be taken out of the direct deposit database. Or if the error report indicates that it has incorrect routing and/or account numbers, the Department of Treasury will contact you by phone using the phone number listed on your authorization form.

Please be advised: Address Verification and Direct Deposit Authorization are two separate forms. The Enrollment Office requires Address Verification forms to be received by July 15th of each calendar year. Address Verification forms not returned by July 15th will result in Enrollment delaying your future per capita disbursements until they can verify your address. Once your address is verified, the per capita disbursements you missed will be issued to you, during the next check run, by means of a paper check, and your direct deposit will start on the next quarterly disbursement.

•All Changes or Cancellations MUST be in writing.

•The Department of Treasury DOES NOT change addresses. You will have to contact Enrollment to change your address. The Department of Treasury only processes direct deposit information, not change addresses for the next per capita distribution.

P.O. Box 640 ~ Black River Falls, WI 54615

(715)284.1660 ~ (800) 779.2873 ~ (715) 284.9972 FAX

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