Form 74-158 - Employee Direct Deposit Authorization - 2009 Page 2
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2Form 74-158 (Back)(Rev.1-07/9)
INSTRUCTIONS FOR
EMPLOYEE DIRECT DEPOSIT AUTHORIZATION
Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you,
with limited exceptions in accordance with Ch. 552, Government Code.
SECTION 1: Check the appropriate box(es)
• NEW SETUP - If payee is not currently on direct deposit with the state.
a. Complete Sections 2, 3 & 4.
b. Section 4 is recommended to be completed by financial institution.
• CANCELLATION - If payee wishes to stop direct deposit with the state.
a. Payee completes Sections 2 & 3.
• INTERAGENCY TRANSFER - For state employees only who transfer from one state agency to another.
a. Employee completes Sections 2, 3 & 4.
b. Employee should submit form to the new paying state agency for completion of Section 6.
• CHANGE FINANCIAL INSTITUTION
a. Payee completes Sections 2, 3 & 4.
b. Section 4 is recommended to be completed by financial institution.
• CHANGE ACCOUNT NUMBER
a. Payee completes Sections 2, 3 & 4.
b. Section 4 is recommended to be completed by financial institution.
• CHANGE ACCOUNT TYPE
a. Payee completes Sections 2, 3 & 4.
b. Section 4 is recommended to be completed by financial institution.
SECTION 2: PAYEE IDENTIFICATION
Item 1 Enter your 9-digit Social Security number.
Item 2 If your 3-digit mail code address identifier is not known, it will be assigned by the paying state agency.
SECTION 3: AUTHORIZATION FOR SETUP, CHANGES OR CANCELLATION
Items 10, 11 The individual authorizing must sign, print their name and date the form.
& 12
NOTE: No alterations to this section will be allowed.
SECTION 4: FINANCIAL INSTITUTION
Section 4 is recommended to be completed by financial institution.
NOTE: Alterations to routing, account number and/or type of account must be initialed by the financial institution
representative or the payee.
SECTION 5: CANCELLATION BY AGENCY
Sections 5 & 6 to be completed by the paying state agency.
SECTION 6: PAYING STATE AGENCY
Section 6 to be completed by the paying agency if the state agency is submitting the form to the Comptroller's
office for processing.
Submit the completed form to your paying state agency.
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