Request To Change Eft Payment Method And/or Bank Information Form - 2002
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2Harrisburg, PA 17121
REQUEST TO CHANGE EFT PAYMENT METHOD AND/OR BANK INFORMATION
c
c
Action Requested:
Change Payment Method
Change Bank Information
Taxpayer Business Name
Federal EIN
UC Account Number
Mailing Address for Electronic Funds Transfer (EFT) Purposes:
STREET ADDRESS
CITY
STATE
ZIP CODE
Payment Method Requested (check one):
c
c
ACH DEBIT
ACH CREDIT
ACH Debit
If you selected ACH Debit, read and complete this section. If you selected ACH Credit, read the next section.
Authorizations for Direct Payments (ACH Debit)
The following provisions shall apply to EFT payments by ACH Debit:
1.
I authorize the Department, the Office of State Treasurer, and their depository financial institution or institutions, to initiate debit entries to
the deposit account indicated below at the depository financial institution named below, and to debit the same to such account. I
acknowledge that the origination of ACH Debit transactions to the account must comply with the provisions of U.S. law.
BANK NAME
CITY
STATE
ZIP CODE
ACCOUNT NUMBER
TRANSIT ROUTING (ABA NUMBER)
ACCOUNT TYPE:
c
CHECKING
c
SAVINGS
2.
I authorize a debit entry to be initiated each time a Form UC-2 is filed electronically. I authorize the debit entry to be in the amount of the
liability set forth on Line 9 of the corresponding Form UC-2. I authorize the Commonwealth to effectuate the debit entry on or after the date
selected when the corresponding Form UC-2 is filed.
3.
To change the depository financial institution or deposit account or both, revoke this authorization for debit entries, or change the
employer’s EFT payment method, the account administrator shall submit a written request to the Department in the form prescribed by the
Department. Any such request shall not be effective until the requested change is reflected in the account information at the e-TIDES
website. This authorization for debit entries may be revoked or modified only in the manner indicated in this paragraph.
4.
For purposes of the UC Law, 43 P.S. § 753 et seq., a payment by ACH Debit is made on the settlement date. Provided, if the settlement date
is later than the date the payment is due, pursuant to Section 305 of the UC Law, 43 P.S. § 785, the payment will be deemed to be made on
the date it is due if the following requirements are met: (a) the corresponding Form UC-2 is filed on or before the date it is due, pursuant to
34 Pa. Code § 63.52, and (b)(i) the payment occurs as a result of the first debit entry initiated by the Commonwealth, or (ii) the payment does
not occur as a result of the first debit entry, but all prior debit entries initiated by the Commonwealth to obtain the payment were rejected
for reasons attributable to the Commonwealth.
UC-140E REV 7-02 (Page 1)
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