"Electronic Deposit Enrollment Form" - Arkansas

Electronic Deposit Enrollment Form is a legal document that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas.

Form Details:

  • Released on March 1, 2018;
  • The latest edition currently provided by the Arkansas Department of Finance & Administration;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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Download "Electronic Deposit Enrollment Form" - Arkansas

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Arkansas Office of Child Support Enforcement
Electronic Deposit Enrollment
Complete the information below to indicate how you would like to receive your child support payments by
electronic deposit. Indicate below if you would like the U.S. Bank ReliaCard or payments by direct deposit. Submit
this form and any other required documents to the following:
Office of Child Support Enforcement
Attn: Electronic Deposit Section
P.O. Box 8128
Little Rock, AR 72203
Or fax to 501-683-7912
Please note: If you have more than one case, payments for all your cases will be disbursed to you by the method
you indicate below. To receive notice of electronic deposits made to your account or prepaid debit card go to
www.childsupport.arkansas.gov and register with the OCSE MyCase customer service site. If you have questions
about electronic deposit, please call 1-866-428-8382.
PLEASE PRINT
Custodial Parent (CP) Name:____________________________________________________________________
First
Middle Initial
Last
CP Social Security Number or Tax ID#: (required) ______________________ Date of Birth _____/_____/_____
Phone Number (cell):__________________________ (home, if different) _______________________________
Email address: ______________________________________________________________________________
Case Number (s):____________________________________________________________________________
Current Mailing Address - Street: _______________________________________________________________
City: __________________________
State: _____
Zip: __________
[ ] I want direct deposit.
Type of Account (check appropriate box):
Reason for this request:
[ ] Checking
[ ] New or re-enrollment
[ ] Savings
[ ] Change in account number or financial institution
MY SIGNATURE BELOW INDICATES MY UNDERSTANDING AND AGREEMENT TO THE FOLLOWING:
1.
I hereby authorize the Office of Child Support Enforcement (OCSE) to disburse child support payments by
sending for deposit payments to the account indicated on the voided check or withdrawal slip provided. I also
authorize my Financial Institution to credit the net amount to my account. This authority will remain in full
effect until OCSE has received written notification from me of this termination.
2.
New enrollments or changes in Financial Institutions will go into effect within five business days from the date
the form is received by OCSE.
3.
I understand that if my bank account changes or closes, and I have not notified OCSE of such change prior to
the scheduled payment date, I will be issued a U.S. Bank ReliaCard unless I submit a new request for direct
deposit.
[ ] I want the U.S. Bank ReliaCard.
This action cancels and replaces any direct deposit agreement I may currently have in place with Arkansas Office of
Child Support Enforcement.
Signature _______________________________________________ Date ________________________________
Rev. 03/18
Arkansas Office of Child Support Enforcement
Electronic Deposit Enrollment
Complete the information below to indicate how you would like to receive your child support payments by
electronic deposit. Indicate below if you would like the U.S. Bank ReliaCard or payments by direct deposit. Submit
this form and any other required documents to the following:
Office of Child Support Enforcement
Attn: Electronic Deposit Section
P.O. Box 8128
Little Rock, AR 72203
Or fax to 501-683-7912
Please note: If you have more than one case, payments for all your cases will be disbursed to you by the method
you indicate below. To receive notice of electronic deposits made to your account or prepaid debit card go to
www.childsupport.arkansas.gov and register with the OCSE MyCase customer service site. If you have questions
about electronic deposit, please call 1-866-428-8382.
PLEASE PRINT
Custodial Parent (CP) Name:____________________________________________________________________
First
Middle Initial
Last
CP Social Security Number or Tax ID#: (required) ______________________ Date of Birth _____/_____/_____
Phone Number (cell):__________________________ (home, if different) _______________________________
Email address: ______________________________________________________________________________
Case Number (s):____________________________________________________________________________
Current Mailing Address - Street: _______________________________________________________________
City: __________________________
State: _____
Zip: __________
[ ] I want direct deposit.
Type of Account (check appropriate box):
Reason for this request:
[ ] Checking
[ ] New or re-enrollment
[ ] Savings
[ ] Change in account number or financial institution
MY SIGNATURE BELOW INDICATES MY UNDERSTANDING AND AGREEMENT TO THE FOLLOWING:
1.
I hereby authorize the Office of Child Support Enforcement (OCSE) to disburse child support payments by
sending for deposit payments to the account indicated on the voided check or withdrawal slip provided. I also
authorize my Financial Institution to credit the net amount to my account. This authority will remain in full
effect until OCSE has received written notification from me of this termination.
2.
New enrollments or changes in Financial Institutions will go into effect within five business days from the date
the form is received by OCSE.
3.
I understand that if my bank account changes or closes, and I have not notified OCSE of such change prior to
the scheduled payment date, I will be issued a U.S. Bank ReliaCard unless I submit a new request for direct
deposit.
[ ] I want the U.S. Bank ReliaCard.
This action cancels and replaces any direct deposit agreement I may currently have in place with Arkansas Office of
Child Support Enforcement.
Signature _______________________________________________ Date ________________________________
Rev. 03/18