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OW Authorization For Direct Deposit English

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OW Authorization For Direct Deposit English

o.w

Uploaded by

icmhamilton2024
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Ministry of Community

and Social Services


Direct Deposit Request
Ontario Disability Support Program
Ontario Works
Important
Your bank account must have withdrawal privileges.
Your funds are deposited at 12:01 a.m. on the payment due date. Remember Automatic Teller Machines operate one day behind.
A monthly Statement of Direct Deposit will be mailed to you.
Creditors may attempt to recover outstanding debts from funds in your bank account. If you have concerns in this regard, please contact your
worker.
If your account number changes or if you change banks notify your worker immediately. Do not close your old account until your Direct Deposit
arrives in your new account.
Please send in or drop off this form at your local office after you have signed it and attached a voided cheque.
Section 1 – Recipient Information
Member ID

Last Name First Name Middle Initial

Address
Unit Number Street Number Street Name PO Box

City/Town Province Postal Code Telephone Number

Section 2 – Direct Deposit Information

Please attach a blank cheque of your bank


and mark it void as indicated. ►

Office Use Only


Input Instructions
• Input starts at the left • Program - ODSP(4), OW(1)
• Extra spaces are left blank • Branch - mandatory 5 digits
• Today’s date - critical for audit trail • Institution - 3 digits
• Office I.D., Case Org. Member I.D. - all mandatory • Account - up to 12 digits, ignore all bars and dashes
Problems
Refer to training manual when:
• Bank account is not in applicant/recipient and where applicable trustee name
Branch Institution Account Number
Today's Date (yyyymmdd) Office ID Case Org. Member Identification Program

Effective Date (yyyymmdd) Branch Institution Account Number

Section 3 – Authorization for Direct Deposit


• I have read and understood the above.
• I understand that the agreement may be revoked at any time by the Ministry / Delivery Agent.
• I hereby authorize direct deposit to the account designated.
Signature Date (yyyy/mm/dd)

Notice with Respect to the Collection of Personal Information


(Freedom of Information and Protection of Privacy Act)
(Municipal Freedom of Information and Protection of Privacy Act)
This information is collected under the legal authority of the Ontario Disability Support Program Act, 1997, sections 5, 10, 45 & 46 or the Ontario Works
Act, 1997, sections 7, 8, 15, 57 & 58 for the purpose of administering Government of Ontario social assistance programs. For more information contact
at , in your local Ontario Works or ODSP office.
0240E (2016/07) © Queen's Printer for Ontario, 2016 Disponible en français
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