Form SOC829 "In-home Supportive Services (Ihss)/Waiver Personal Care Services (Wpcs) Provider Direct Deposit Enrollment/Change/Cancellation Form" - California

What Is Form SOC829?

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

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the California Department of Social 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 SOC829 by clicking the link below or browse more documents and templates provided by the California Department of Social Services.

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Download Form SOC829 "In-home Supportive Services (Ihss)/Waiver Personal Care Services (Wpcs) Provider Direct Deposit Enrollment/Change/Cancellation Form" - California

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State of California – Health and Human Services Agency
California Department of Social Services
IN-HOME SUPPORTIVE SERVICES (IHSS) / WAIVER PERSONAL CARE
SERVICES (WPCS) PROVIDER DIRECT DEPOSIT ENROLLMENT/
CHANGE/CANCELLATION FORM
PROVIDER NAME (FIRST, MIDDLE, LAST)
STREET
CITY
STATE
ZIP CODE
Check Appropriate Box:
NEW
By checking this box, I hereby authorize the State controller’s Office to directly deposit my pay
warrants to my personal bank account.
CHANGE By checking this box, I hereby authorize the State controller’s Office to change my Direct
Deposit to my new personal bank account.
CANCEL By checking this box, I hereby cancel my Direct Deposit authorization.
CASE NUMBER:
PROVIDER NUMBER:
TYPE OF ACCOUNT:
CHECKING
SAVINGS (CHECK ONLY ONE TYPE)
ROUTING NUMBER: (MUST BE 9 NUMBERS)
ACCOUNT #:
BANK NAME:
By signing you acknowledge that you will not send 100% of funds deposited to your bank to another bank
outside the US.
SIGNATURE OF PAYEE (PROVIDER)
DATE
Please send your COMPLETED Enrollment/Change/Cancellation Form to:
PROVIDER FORMS PROCESSING CENTER
P.O. BOX 1697
West Sacramento, CA 95691-6697
It takes 30 days for you to start receiving Direct Deposit after you submit your request. Your request for Direct
Deposit does not change the way you submit your timesheets, so make sure you continue to submit your
timesheets as you wait for your Direct Deposit to begin.
SOC 829 (10/18)
Page 1 of 2
State of California – Health and Human Services Agency
California Department of Social Services
IN-HOME SUPPORTIVE SERVICES (IHSS) / WAIVER PERSONAL CARE
SERVICES (WPCS) PROVIDER DIRECT DEPOSIT ENROLLMENT/
CHANGE/CANCELLATION FORM
PROVIDER NAME (FIRST, MIDDLE, LAST)
STREET
CITY
STATE
ZIP CODE
Check Appropriate Box:
NEW
By checking this box, I hereby authorize the State controller’s Office to directly deposit my pay
warrants to my personal bank account.
CHANGE By checking this box, I hereby authorize the State controller’s Office to change my Direct
Deposit to my new personal bank account.
CANCEL By checking this box, I hereby cancel my Direct Deposit authorization.
CASE NUMBER:
PROVIDER NUMBER:
TYPE OF ACCOUNT:
CHECKING
SAVINGS (CHECK ONLY ONE TYPE)
ROUTING NUMBER: (MUST BE 9 NUMBERS)
ACCOUNT #:
BANK NAME:
By signing you acknowledge that you will not send 100% of funds deposited to your bank to another bank
outside the US.
SIGNATURE OF PAYEE (PROVIDER)
DATE
Please send your COMPLETED Enrollment/Change/Cancellation Form to:
PROVIDER FORMS PROCESSING CENTER
P.O. BOX 1697
West Sacramento, CA 95691-6697
It takes 30 days for you to start receiving Direct Deposit after you submit your request. Your request for Direct
Deposit does not change the way you submit your timesheets, so make sure you continue to submit your
timesheets as you wait for your Direct Deposit to begin.
SOC 829 (10/18)
Page 1 of 2
IN-HOME SUPPORTIVE SERVICES
PROVIDER DIRECT DEPOSIT ENROLLMENT INSTRUCTIONS
You are not eligible for Direct Deposit if you are planning to send 100% of funds deposited to your bank to
another bank outside the US.
You will need the following information to complete the Direct Deposit Enrollment Form:
1.
The name of your Bank.
2.
The Bank Routing Number
3.
Your Checking or Savings Account Number. If you need help identifying this information please ask
your Bank for assistance.
CHECK APPROPRIATE BOX
Please check the box to tell us what you want to do. Check the Box: NEW to enroll in direct deposit; CHANGE
to change your bank account; and CANCEL to cancel direct deposit.
Check the box to tell us whether you want your paycheck deposited in your checking or savings account.
IDENTIFICATION INFORMATION
Provide your Case and Provider number. You will find the case and provider numbers on your IHSS statement
of earnings (pay stub).
BANKING INFORMATION
Provide the information requested on the form. You may find the bank information you will need to complete
the enrollment form on your personal checks or your bank may assist you. Below is an example of a check
and where to find the necessary information.
Check Example:
If you prefer to have your money deposited into your savings account, please contact your bank for assistance.
PROVIDE ALL REQUESTED INFORMATION
All information requested on the form must be provided. Incomplete forms will be returned. To enroll in Direct
Deposit you must complete all fields on an Enrollment/change/Cancellation form. Your signature authorizing
direct deposit must be an ORIGINAL SIGNATURE, photocopies will not be accepted.
IF YOU WORK FOR MULTIPLE RECIPIENTS
You must complete a separate Provider Enrollment/Change/Cancellation form for EACH Recipient with whom
you are employed. When you begin work for a new recipient you will need to complete a new form.
CHANGING OR CANCELING YOUR DIRECT DEPOSIT
Your Direct Deposit will continue to be deposited into the bank account you have chosen until you request a
change. If you wish to change or cancel your Direct Deposit authorization for any recipient for whom you work,
you must submit an Enrollment/Change/Cancellation form with a check next to the box for Change or Cancel.
You may access our website at www.cdss.ca.gov/inforesources/Forms-Brochures to download additional forms
or contact the Direct Deposit Help desk toll free at (866) 376-7066.
Please send your COMPLETED Enrollment/Change/Cancellation Form to:
PROVIDER FORMS PROCESSING CENTER
P.O. BOX 1697
West Sacramento, CA 95691-6697
SOC 829 (10/18)
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