Employee Direct Deposit Form - Oregon Department Of Administrative Services
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1
2Instructions for Employee Direct Deposit Form
Allow at least fourteen (14) business days for a new direct deposit set‐up.
If you are signing up for the US Bank Focus® Card DO NOT USE THIS FORM. Use the Pay Card Authorization
form. OSPS.99.19
Fill out this form completely and return to your Agency Payroll Office. Attach a void check for each checking account. If
depositing to a savings account or pre‐loaded bank card ask your bank to give you the Routing/Transit number for your
account, this number isn’t always the same as shown on the deposit slip. It is your responsibility to provide complete and
accurate account information.
•
Employee Oregon ID # ‐ This is your 9 digit employee number as assigned in the personnel system. This OR# can be
found on your pay statement or personnel action documents. Contact your agency payroll or human resource office
for assistance. DO NOT USE YOUR SOCIAL SECURITY NUMBER.
•
Email Address – the email address that you will use for your ePayroll account, a work or personal email address is
acceptable.
•
New – Select to add a brand new account for a fixed or net pay deposit.
•
Cancel * – Select to cancel an existing deposit. Please be sure to include the routing and account numbers on the form.
•
Replace* – Select to replace an existing or net pay account or to replace a fixed deposit account and/or amount.
•
Bank Name/City/State – The name of the financial institution you are depositing to and location of the branch where
you have your account (if known).
•
Routing/Transit # ‐ The 9 digit ABA number found on your check (see example below). Contact your bank for
assistance.
•
Account # ‐ The account number where you wish to have the funds deposited.
•
Travel Reimbursements – Indicate this box only if you expect to travel for your agency and be reimbursed through
the accounting system (SFMA) (choose only ONE account).
•
Dep. Amount or Net amount – Fixed dollar amount or remainder of check (net amount selection required
for participation in ePaystub program).
Once a net pay deposit is established, you will receive your paystub electronically. (OAR. 125‐015‐0200 or applicable policy).
Paystubs can be accessed at:
*If you are canceling your net pay direct deposit, you may receive a paper check and paper stub on your next scheduled
payday.
Electronic Deposit/ePaystub (OAR. 125‐015‐0200)
Employees choosing to use one of the exception criteria to receive direct deposit but not participate in ePaystub, will be
automatically enrolled in direct deposit and ePaystub until verification by payroll/human resources of the exception criteria is
completed. Employees are responsible for getting the proper verification for meeting the exception criteria from their agency
payroll or human resources staff.
INSTRUCTIONS TO PAYROLL OFFICES
DO NOT SUBMIT TO OSPS
The completed form is Information Asset Classification Level 3 as defined by the Enterprise Security Office.
Refer to the Secretary of State, Archives Division Administrative Rules for retention guidelines.
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