Form DHS-3371-ENG "Child Support Direct Deposit Authorization Form" - Minnesota

What Is Form DHS-3371-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Minnesota Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DHS-3371-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

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Download Form DHS-3371-ENG "Child Support Direct Deposit Authorization Form" - Minnesota

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DHS-3371-ENG 10-17
Direct deposit for your
child support payments
Fast, convenient, safe and efficient
What is direct deposit?
Starting direct deposit
Direct deposit is an electronic method of payment.
Complete the authorization form and mail it to the
The Minnesota Department of Human Services’ Child
address on the form. If you want direct deposit into a:
Support Division uses direct deposit to transfer child
Checking account:
Include a voided, blank check or
support payments into your checking or savings
have a representative from your financial institution
account, or into a stored value card account.
com plete your account information on the form.
What is a stored value card account?
Savings account:
Include a deposit slip preprinted with
A stored value card account is called ReliaCard Visa
your account information or have a representative
and works like a debit card. After your child support
from your financial institution complete your account
is electronically deposited into your account, you can
information on the form.
withdraw money at automated teller machines (ATMs)
Stored value card account (Reliacard
):
Complete a
®
or use your card to make purchases at stores that
stored value card application and follow the U.S. Bank
®
accept most major credit cards. It is not a credit card
form instructions.
and you cannot deposit other funds into your stored
value card account.
Changing direct deposit
The stored value card account is offered and serviced
To change your direct deposit from one account to
by U.S. Bank
, not the state of Minnesota. If you
®
another, you need to complete a new direct deposit
choose to receive your child support payments through
authorization form. To get this form:
a stored value card account, you must enter into and
follow a cardholder agreement with U.S. Bank
®
Call the Child Support Payment and
■ ■
.
Account Information Line at 651-431-4340 or
Getting your child support
800-657-3512, press 2 for direct deposit
Funds are usually available to you two business days
information. At the direct deposit menu, press 2 for
after the Child Support Division credits a payment to
set-up or change information, and press 2 again to
your child support case. To verify that payments are
have the form mailed or faxed to you.
(or have been) credited to your child support case,
Online: at mn.gov/dhs. Search for ‘changing direct
■ ■
call the Child Support Payment and Account
deposit’.
Information Line at 651-431-4340 or 800-657-3512.
Pick the form up at your county child support office.
■ ■
To verify that payments have been credited to your
Account changes are limited to two changes per month.
checking, savings or stored value card account, call
your financial institution.
If you have questions
Paying direct deposit fees
For questions about direct deposit, call the
Child Support Payment Line at 651-431-4340 or
The department does not charge fees for direct
800-657-3512. For TTY service, call the Minnesota
deposit. Contact your financial institution for
Relay Service at 711 or 800-627-3529 and ask them
information about fees it may charge. U.S. Bank
®
to call the Child Support Payment Line. For the Speech-
may charge fees on some stored value card account
to-Speech Relay, call 877-627-3848.
transactions, including cash withdrawals, ATM
withdrawals and overdrafts.
DHS-3371-ENG 10-17
Direct deposit for your
child support payments
Fast, convenient, safe and efficient
What is direct deposit?
Starting direct deposit
Direct deposit is an electronic method of payment.
Complete the authorization form and mail it to the
The Minnesota Department of Human Services’ Child
address on the form. If you want direct deposit into a:
Support Division uses direct deposit to transfer child
Checking account:
Include a voided, blank check or
support payments into your checking or savings
have a representative from your financial institution
account, or into a stored value card account.
com plete your account information on the form.
What is a stored value card account?
Savings account:
Include a deposit slip preprinted with
A stored value card account is called ReliaCard Visa
your account information or have a representative
and works like a debit card. After your child support
from your financial institution complete your account
is electronically deposited into your account, you can
information on the form.
withdraw money at automated teller machines (ATMs)
Stored value card account (Reliacard
):
Complete a
®
or use your card to make purchases at stores that
stored value card application and follow the U.S. Bank
®
accept most major credit cards. It is not a credit card
form instructions.
and you cannot deposit other funds into your stored
value card account.
Changing direct deposit
The stored value card account is offered and serviced
To change your direct deposit from one account to
by U.S. Bank
, not the state of Minnesota. If you
®
another, you need to complete a new direct deposit
choose to receive your child support payments through
authorization form. To get this form:
a stored value card account, you must enter into and
follow a cardholder agreement with U.S. Bank
®
Call the Child Support Payment and
■ ■
.
Account Information Line at 651-431-4340 or
Getting your child support
800-657-3512, press 2 for direct deposit
Funds are usually available to you two business days
information. At the direct deposit menu, press 2 for
after the Child Support Division credits a payment to
set-up or change information, and press 2 again to
your child support case. To verify that payments are
have the form mailed or faxed to you.
(or have been) credited to your child support case,
Online: at mn.gov/dhs. Search for ‘changing direct
■ ■
call the Child Support Payment and Account
deposit’.
Information Line at 651-431-4340 or 800-657-3512.
Pick the form up at your county child support office.
■ ■
To verify that payments have been credited to your
Account changes are limited to two changes per month.
checking, savings or stored value card account, call
your financial institution.
If you have questions
Paying direct deposit fees
For questions about direct deposit, call the
Child Support Payment Line at 651-431-4340 or
The department does not charge fees for direct
800-657-3512. For TTY service, call the Minnesota
deposit. Contact your financial institution for
Relay Service at 711 or 800-627-3529 and ask them
information about fees it may charge. U.S. Bank
®
to call the Child Support Payment Line. For the Speech-
may charge fees on some stored value card account
to-Speech Relay, call 877-627-3848.
transactions, including cash withdrawals, ATM
withdrawals and overdrafts.
Attention. If you need free help interpreting this document, ask your worker or call the number below for
your language.
ያስተውሉ፡ ይህንን ዶኩመንት ለመተርጎም እርዳታ የሚፈልጉ ከሆነ፡ የጉዳዮን ሰራተኛ ይጠይቁ ወይም በሰልክ ቁጥር 1-844-217-3547
ይደውሉ።
.1-800-358-0377 ‫مالحظة: إذا أردت مساعدة مجانية لترجمة هذه الوثيقة، اطلب ذلك من مشرفك أو اتصل على الرقم‬
သတိ ။ ဤစာရြ က ္ စ ာတမ္ း အားအခမဲ ့ ဘ ာသာျပန္ ေ ပးျခင္ း အကူ အ ညီ လ ု ု ိ အ ပ္ ပ ါက၊ သင္ ့ လ ူ မ ွ ဳ ေရးအလု ု ပ ္ သ မား အားေမးျမန္ း ျခင္ း သု ု ိ ့ မ ဟု ု တ ္
1-844-217-3563
ကု ု ိ ေ ခၚဆု ု ိ ပ ါ။
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1-888-468-3787
.
請注意 , 如果您需要免費協助傳譯這份文件 , 請告訴您的工作人員或撥打1-844-217-3564。
Attention. Si vous avez besoin d’une aide gratuite pour interpréter le présent document, demandez à votre
agent chargé du traitement de cas ou appelez le 1-844-217-3548.
Thov ua twb zoo nyeem. Yog hais tias koj xav tau kev pab txhais lus rau tsab ntaub ntawv no pub dawb,
ces nug koj tus neeg lis dej num los sis hu rau 1-888-486-8377.
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1-844-217-3549
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알려드립니다. 이 문서에 대한 이해를 돕기 위해 무료로 제공되는 도움을 받으시려면 담당자에게
문의하시거나 1-844-217-3565으로 연락하십시오.
ໂປຣດຊາບ. ຖ ້ າ ຫາກ ທ ່ າ ນຕ ້ ອ ງການການຊ ່ ວ ຍເຫຼ ື ອ ໃນການແປເອກະສານນ ີ ້ ຟ ຣ ີ , ຈ ົ ່ ງ ຖາມພະນ ັ ກງານກ � າກ ັ ບການຊ ່ ວ ຍເຫຼ ື ອ
ຂອງທ ່ າ ນ ຫຼ ື ໂທຣໄປທ ີ ່ 1-888-487-8251.
Hubachiisa. Dokumentiin kun tola akka siif hiikamu gargaarsa hoo feete, hojjettoota kee gaafadhu ykn afaan
ati dubbattuuf bilbili 1-888-234-3798.
Внимание: если вам нужна бесплатная помощь в устном переводе данного документа, обратитесь к
своему социальному работнику или позвоните по телефону 1-888-562-5877.
Digniin. Haddii aad u baahantahay caawimaad lacag-la’aan ah ee tarjumaadda qoraalkan, hawlwadeenkaaga
weydiiso ama wac lambarka 1-888-547-8829.
Atención. Si desea recibir asistencia gratuita para interpretar este documento, comuníquese con su trabajador
o llame al 1-888-428-3438.
Chú ý. Nếu quý vị cần được giúp đỡ dịch tài liệu này miễn phí, xin gọi nhân viên xã hội của quý vị hoặc
gọi số 1-888-554-8759.
For accessible formats of this publication and additional equal access to
human services, write to DHS.info@state.mn.us, call 651-431-4400, or
use your preferred relay service.
(ADA1 [9-15])
Clear Form
Clear Form
*DHS-3371-ENG*
DHS-3371-ENG
10-17
Child support direct deposit authorization form
Complete the form, read and sign below if you have chosen child support direct deposit to a checking or
Instructions:
savings account.
PRINT LAST NAME
FIRST NAME
MIDDLE INITIAL
SOCIAL SECURITY NUMBER
HOME PHONE
WORK PHONE
Please choose one of the following:
Checking.
I request direct deposit into my checking
Savings.
I request a direct deposit into my savings
account. I have included a voided blank check with my
account. I have included a deposit slip preprinted
account information or have had a bank representative
with my account information or have had a bank
complete the account information on this form.*
representative complete the account information
on this form.*
OR
For a stored value card. Complete a separate application for a stored value card account.
*For direct deposit to a checking or savings account, have a bank representative complete the following information
if you do not have a voided, blank check or a preprinted savings deposit slip for this account.
To be completed by bank representative:
By signing this form you are verifying that this bank account belongs to the applicant named on this form.
ROUTING NUMBER
CHECKING OR SAVINGS ACCOUNT NUMBER
SIGNATURE OF BANK REPRESENTATIVE
BANK/BRANCH NAME
Statement of understanding and authorization for direct deposit
Read and sign below if you have chosen direct deposit into a checking or savings account. I understand:
By signing this form, I authorize the Minnesota Department of Human Services, Child Support Division, to deposit
■ ■
my child support payments electronically to the account I have checked. This action cancels and replaces any direct
deposit agreement I currently have in place with the Child Support Division.
While I am not legally required to submit the information on this form, I understand that the Child Support Division
■ ■
requires it to set up and maintain direct deposit of my child support. The Child Support Division will share this
information only with its financial institution and with the financial institution I designate on the form, and only for
the limited purpose of setting up and administering direct deposit to my account.
SIGNATURE OF APPLICANT
DATE
Mail or fax authorization form to:
For office use only
Minnesota Child Support Payment Center
Received date:
EFT ARW
P.O. Box 64329
Active date:
St. Paul, MN 55164-0329
Fax: 651-431-7469
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