Direct Deposit Authorization - Division Of Child Support Enforcement/sdu

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PO Box 586
Commonwealth of Virginia
Richmond, VA 23218
Department of Social Services
Division of Child Support Enforcement
1-800-468-8894
DIRECT DEPOSIT AUTHORIZATION
Date: _________________________
Name:
_______________________________________
Address: _______________________________________
_______________________________________
This is a:
New Request
Change Bank Accounts
Request DCSE cancel my direct deposit.
I am closing my case.
Social Security
Number:
____________________________________________________
Case Number:
____________________________________________________
Bank Name:
____________________________________________________
Home Phone
______________________ Work Phone ____________________ Cell Phone ______________________
Account Type:
Checking
Savings
Account Number ______________
Routing Number __________________
Detach this page from the application and send this completed form, along with either:
a voided check,
deposit slip,
bank statement with your name and bank account number or
an Account Verification form prepared by your bank
with your name and bank account number preprinted on the form to
I authorize the Division of Child Support Enforcement to make deposits to this bank account until I change this
authorization.
Signature:
Date:
Print Name: ________________________________________________________
Please allow DCSE 15-30 days to process a Direct Deposit request. The Division will notify you when your request is set up.
Direct Deposit will start 15 days after pre-notification. Funds will be available, in most instances, for use within 2 business
days after DCSE applies the payment to your case. If you have questions, please contact our Customer Service Center at 1-
800-468-8894.
Send this completed form to:
Division of Child Support Enforcement/SDU
Attn: EFT Disbursement Unit
P.O. Box 586
Richmond VA 23218-0856
OR
Fax to: 804-726-7955
NOTICE: Federal law requires all people subject to child support orders to provide their social security numbers. We take
your privacy very seriously. Social security numbers are kept in the case records and are only used to locate parents to
establish paternity and establish, modify, and enforce support obligations.
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032-11-0200A-20-eng (03/2017)

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