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- "Reversal or Return of Direct Deposit Request" - Ohio
"Reversal or Return of Direct Deposit Request" - Ohio
Reversal or Return of Direct Deposit Request is a legal document that was released by the Ohio Department of Administrative Services - a government authority operating within Ohio.
Form Details:
- Released on June 1, 2015;
- The latest edition currently provided by the Ohio Department of Administrative Services;
- 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Ohio Department of Administrative Services.
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2 REVERSAL or RETURN of DIRECT DEPOSIT REQUEST
EMPLOYEE DATA:
NAME _____________________________________________________ EMPL ID# ___________________________
Full Time ____________ Part Time ______________ Temporary ______________
Agency Name & Number ______________________________ PPE _____________ Payday ______________
REASON FOR REQUEST: ________________________________________________________________________
PREVENT DIRECT DEPOSIT ________ REVERSE DIRECT DEPOSIT ________ RETURNED BY BANK ______________
EFT RECORD HAS BEEN CORRECTED ________ CANCELLED __________
ACCOUNT INFORMATION (at time of Deposit)
CHECKING ____________ SAVINGS _____________
TRANSIT ROUTING NUMBER ___________________________
ACCOUNT NUMBER _______________________________
WARRANT NUMBER __________________________ AMOUNT DEPOSITED/RETURNED _____________________________
WAS THERE AN ATTACHMENT? YES ________ NO __________
AMOUNT ____________________________
OVERPAID (NO PAY DUE)
_____________________________
OVERPAID (PAY DUE ONLY): FILL OUT PAGE TWO
Deductions that need to be taken on check written for an overpayment: _____________________________________________
SIGNATURE:
Agency Approval ___________________________________ Date __________________________ Time ______________________
Telephone ______________________________________ Ext _________________ Fax # __________________________________
Date: ______________________
Prepared by: ________________ Gross: __________________ Net: __________________ Check # ________________ Stock # _______________________
I ACKNOWLEDGE RECEIPT OF A CHECK WITH THE ABOVE NUMBER, DATE AND PAYEE
SIGN HERE ____________________________________________________ DATE _____________________________________________
FAX APPROVED FORM TO: DAS HRD PAYROLL SERVICES @ 614.466.1565
NOTE: Form will only be processed if it is approved by an authorized agency central office employee
Revised 06‐01‐2015
REVERSAL or RETURN of DIRECT DEPOSIT REQUEST
EMPLOYEE DATA:
NAME _____________________________________________________ EMPL ID# ___________________________
Full Time ____________ Part Time ______________ Temporary ______________
Agency Name & Number ______________________________ PPE _____________ Payday ______________
REASON FOR REQUEST: ________________________________________________________________________
PREVENT DIRECT DEPOSIT ________ REVERSE DIRECT DEPOSIT ________ RETURNED BY BANK ______________
EFT RECORD HAS BEEN CORRECTED ________ CANCELLED __________
ACCOUNT INFORMATION (at time of Deposit)
CHECKING ____________ SAVINGS _____________
TRANSIT ROUTING NUMBER ___________________________
ACCOUNT NUMBER _______________________________
WARRANT NUMBER __________________________ AMOUNT DEPOSITED/RETURNED _____________________________
WAS THERE AN ATTACHMENT? YES ________ NO __________
AMOUNT ____________________________
OVERPAID (NO PAY DUE)
_____________________________
OVERPAID (PAY DUE ONLY): FILL OUT PAGE TWO
Deductions that need to be taken on check written for an overpayment: _____________________________________________
SIGNATURE:
Agency Approval ___________________________________ Date __________________________ Time ______________________
Telephone ______________________________________ Ext _________________ Fax # __________________________________
Date: ______________________
Prepared by: ________________ Gross: __________________ Net: __________________ Check # ________________ Stock # _______________________
I ACKNOWLEDGE RECEIPT OF A CHECK WITH THE ABOVE NUMBER, DATE AND PAYEE
SIGN HERE ____________________________________________________ DATE _____________________________________________
FAX APPROVED FORM TO: DAS HRD PAYROLL SERVICES @ 614.466.1565
NOTE: Form will only be processed if it is approved by an authorized agency central office employee
Revised 06‐01‐2015
PAGE TWO FOR REVERSAL or RETURN OF DIRECT DEPOSIT REQUEST
Key EC = Earnings Code D/H=Dollars/Hours
Name_____________________________________________________ EMPLID ________________ AGENCY ____________________
If manual for Additional pay or $ earnings - E C ________________ D/H___________
If re-write - EC _________ D/H_________ EC ________ D/H ________ EC ________ D/H ________
EC ________ D/H ________ EC ________ D/H ________ EC ________ D/H ________
S
M
T
W
TH
F
S
S
M
T
W
TH
F
S
S
M
T
W
TH
F
S
EACH SET OF BLOCKS REPRESENTS A PAY PERIOD TIME FRAME. IF THE REQUEST IS FOR MORE THAN ONE PAY
PERIOD, PLEASE ENSURE YOU FILL IN EACH PAY PERIOD SEPARATELY.
FILL IN THE DATES WITH THE CORRECT CORRESPONDING DAY IN THE PAY PERIOD FOR THE MANUAL
REQUESTED.
REMEMBER TO USE THE APPROPRIATE TRC CODE.
PAYDAY WEEKS-PLEASE ENTER TIME IN OAKS TIMESHEET.
PAY PROCESSING WEEKS-DO NOT ENTER THE TIME IN THE OAKS TIMESHEET (THIS WILL DELAY THE
PROCESSING OF THE MANUAL)
REMEMBER TO ENTER A COMMENT IN THE BUBBLE ON THE OAKS TIMESHEET-(DAS/HRD PAYROLL WILL ENTER
COMMENT AND TIME FOR REQUESTS ON PAY PROCESSING WEEK)
FOR APPROVING AGENCIES, DAS/HRD PAYROLL WILL APPROVE THE PAYABLE TIME WITH THE AUTHOR
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