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 STATE of CONNECTICUT OFFICE of the STATE COMPTROLLER Page 2015-2023

STATE of CONNECTICUT OFFICE of the STATE COMPTROLLER Page 2015-2023

Use a STATE OF CONNECTICUT OFFICE OF THE STATE COMPTROLLER Page 2015 template to make your document workflow more streamlined.

Organization. This payee designation will be accepted by RSD and will be sufficient for direct deposit changes. For direct deposit and direct deposit changes only RSD will accept a copy of the Representative Payee designation made by the Commissioner of Social Security. I. SOC SEC NO. EMPLOYEE NO. MEMBER S ADDRESS Street No. Name City State Zip Code PART III - DESIGNATION OF ATTORNEY- IN-FACT AGENT Type or Clearly Print This Information The individual you wish to designate as your...
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