Can this form be signed electronically?

Yes. Electronic signatures are legally binding under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and a retained reproducible record.

Is notarization required?

Not generally. Notarization is uncommon for direct deposit authorizations, but an employer or payer may require notarization or RON for higher-risk transactions; check employer policy and state notary rules.

How do I correct a wrong routing number?

Submit a revised signed authorization promptly and notify payroll or the bank. Corrective debit/credit steps may be needed; bank returns can incur fees and reconciliation work.

How can a payer verify account ownership?

Common methods include a voided check, micro-deposit verification, or bank confirmation. Proper verification reduces misdirected payments and fraud risk.

How do I revoke authorization?

Provide written notice to the payer per the authorization terms; allow the payer reasonable time to process the revocation before stopping deposits to avoid disputes.

What records should be retained?

Retain the signed authorization and audit trail in secure storage per IRS and industry rules; healthcare records are subject to HIPAA retention (45 CFR §164.530(j)).

Electronic Signature
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Healthcare
Direct Deposit Authorization for Electronic Funds Transfer

Direct Deposit Authorization for Electronic Funds Transfer

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Direct Deposit Authorization for Electronic Funds Transfer (EFT)

Minnesota Management & Budget

File Maintenance
400 Centennial Office Bldg
658 Cedar Street
St. Paul, MN 55155

EFT Helpline 651-201-8106
Fax 651-797-1305
efthelpline.mmb@state.mn.us

Instructions for completing this form are on the back. Please print clearly and use black ink.

Mailing Address (General)

Name

Address

City

State Zip Code Vendor Number

Contact Information - Please list person who can respond if additional information is required.

Contact Name

Email Address

Phone Ext Fax

Tax Identification Information

Federal ID/Social Security Number

Federal ID/Social Security Name

MN State ID Number (If a business located within Minnesota)

Financial Institution Information

ABA Routing Number

Customer Account Number

Financial Institution

Street Address

City, State, ZIP Code

Type of Account: Checking Savings

Authorization to Make Electronic Fund Payments

I authorize the Commissioner of Minnesota Management & Budget to deposit, by electronic fund transfer, payments owed to me by the State of Minnesota and, if necessary, debit entries and adjustments for any amounts deposited electronically in error. The Commissioner shall deposit the payments in the financial institution and account designated above. I recognize that if I fail to provide complete and accurate information on this authorization form, the processing of the form may be delayed or my payments may be erroneously transferred electronically.

I consent to and agree with the National Automated Clearing House Association Rules and Regulations and the Commissioner's Rule about electronic transfers as they exist on the date of my signature on this form or as subsequently adopted, amended or repealed.

Authorized Signature

Printed Name

Title

Date

Completing the Direct Deposit Authorization for Electronic Fund Transfer (EFT) Form

Notice of Intent to Collect Private Data

All payment recipients are asked to provide private data to Minnesota Management & Budget for the following purposes. State employees who support this function of the state's accounting system need to access the data to verify information. Others who have legal access to the data include: Legislative Auditor, Attorney General, enforcement agencies with statutory authority, and any other person or entity authorized by law or court order.

Social Security Number (SSN) or Federal Employee Identification Number (FEIN): Needed for identification purposes. This number is used to match recipients with payments. This number is also called a Tax Identification Number or TIN number. You are not legally required to provide this data. However, without this information we cannot convert you to EFT.

ABA Routing Number, Account Number, Account Type: This data is required to correctly deposit payments to your designated bank account. You are required by law to provide this information. Incomplete information may cause a delay in converting to EFT. Additionally, incorrect information may cause a payment to be delayed or deposited to the wrong account.

Instructions for Completing the Form

Determine which bank accounts will be used for direct deposit. A separate copy of the Electronic Fund Transfer Authorization form is required for each bank account.

Mailing Address (General)

1. Name, Address, City, State, Zip Code. Enter the name of the business or individual, address, city, state, and zip code.

2. Number. Enter the eleven-digit vendor number, if you know it. If you received this form with a letter, this number is located under the date. If you received this form with a duplicate warrant, the number is located above your name and is listed as "Vendor Number" and "Vendor Location."

Contact Information

Enter the name, email address, phone and FAX number of the person who can respond to questions regarding the information provided on this form.

Tax Identification Information

1. Federal ID/Social Security Number and Name. Enter the nine-digit Federal Employer Identification Number (FEIN) for business, or the nine-digit Social Security Number (SSN). Enter the name associated with either the FEIN or SSN listed on the form.

2. MN State ID Number. For businesses located in Minnesota, enter the MN state tax identification number.

Current Financial Institution Information

This information is required to verify that we are changing the correct account.

1. ABA Routing Number. Enter the ABA Routing Number to identify your financial institution. Contact your bank if you are not sure what number to put in this field.

2. Customer Account Number. Enter your bank account number. Contact your bank if you are not sure what number to put in this field.

3. Financial Institution Name. Enter the name and address of your financial institution.

New Account Information

1. ABA Routing Number. Enter the ABA Routing Number to identify your financial institution. Contact your bank if you are not sure what number to put in this field.

2. Customer Account Number. Enter your bank account number. Contact your bank if you are not sure what number to put in this field.

3. Financial Institution Name, Address, City, State, Zip Code. Enter the name and address of your financial institution.

4. Type of Account. Indicate if the account listed on this form is a checking or savings account.

Authorization to Make Electronic Fund Payments

Sign the form and print your name and title (if any) and the date.

Send the Form

You can mail or fax the form to the Department of Military Affairs.

Department of Military Affairs
Veterans Service Building
20 West 12th Street
St. Paul, MN 55155-2098
Attn: Education Services
FAX number: (651) 282-4125
Email: Education @mn.ngb.army.mil

Questions about this Form?

Call the Minnesota Management & Budget EFT Helpline at (651) 201-8106 or efthelpline.mmb@state.mn.us

What the Direct Deposit Authorization for Electronic Funds Transfer Is

A Direct Deposit Authorization for Electronic Funds Transfer is a signed instruction that authorizes an employer, payer, or benefits administrator to deposit funds directly into a named bank account. The form typically captures the account holder's legal name, bank routing number, account number, account type, and explicit permission to credit and, where applicable, debit the account for corrections. It creates a record of consent that supports electronic payment workflows, reconciliation, and fraud controls while replacing paper check distribution and improving payment speed and accuracy.

Why businesses and payees rely on a direct deposit authorization

Direct deposit authorization reduces manual handling, lowers risk of payment errors, and shortens settlement cycles. It documents payer and payee consent for ACH or other electronic transfers, simplifies payroll and vendor payments, and supports audit trails required for internal control and regulatory compliance.

Who typically completes a Direct Deposit Authorization

Common users range from individual employees to payroll and accounts payable teams; the form suits any payer–payee relationship that shifts from paper checks to ACH or electronic transfers.

Employees and contractors who want pay routed into their bank accounts for payroll or reimbursements.
Payroll, HR, and accounts payable staff who collect verified payment instructions from payees.
Benefits administrators and insurers that issue recurring benefit or claim payments electronically.

The authorization remains useful across employment, vendor, government benefit, and insurance payment contexts where secure, documented consent is required.

Typical signatories and their roles

Account Holder

The individual or business whose bank account will receive deposits. The account holder must provide accurate routing and account numbers, confirm account ownership, and sign to demonstrate intent and consent for electronic transfers.

Payroll Administrator

A designated representative of the payer who verifies the form, records routing details in payroll or AP systems, and retains the authorization for reconciliation, audit, and tax reporting purposes.

Essential fields to collect on the authorization

Account holder: Full legal name

Bank name: Depositary institution

Routing number: 9-digit ABA routing

Account number: Full account digits

Account type: Checking or savings

Signature & date: Signed consent date

Step-by-step: filling and submitting a direct deposit authorization

Follow these core steps to capture authorization cleanly, verify account details, and route the instruction to payroll or payments.

01

1. Collect information: Gather name, routing, account number, and account type.
02

2. Verify account: Confirm via voided check or micro-deposit verification.
03

3. Obtain signature: Get a signed authorization dated and attributable to the payer.
04

4. Record and route: Enter into payroll/AP system and retain the form for audit.

Configuring an electronic workflow for online completion

Map fields, signer roles, and verification steps before launching the online authorization form to avoid rework and ensure compliance.

Field	Configuration
Routing number field	Numeric mask, required validation
Account number field	Masked input, copy prevention
Signature field	E-sign enabled, capture timestamp
Verification step	Micro-deposit or voided check upload

Where to send the completed authorization and how it flows

Once signed, transmit the authorization to the payer's payment system and follow verification and activation steps before live deposits occur.

Submit to payroll: Upload into payroll or AP platform for processing.
Bank verification: Bank confirms routing/account or via micro-deposit.
Activate deposit: Payroll schedules first deposit after verification.
Record retention: Store signed file in secure records for audits.

Technical considerations for eSubmission and signing

Choose a platform that supports secure file storage, audit trails, and appropriate signer authentication for the risk level of the payment.

File formats: PDF, DOCX accepted
Authentication: Email/SMS or stronger MFA
Audit trail: IP, timestamp, action log

Ensure the chosen system meets your security, compliance, and integration requirements with payroll or bank platforms before deployment.

Timelines and processing expectations

Processing times vary by payer and bank; plan around payroll cycles and bank cutoff times to ensure timely deposits and corrections.

Payroll cutoff:

Submit changes at least two business days before pay date

Bank processing:

ACH typically completes in 1–2 business days

Micro-deposit verification:

Allow 1–3 business days for small deposits

Change effective date:

Depends on payroll cycle; consult payroll schedule

Revocation notice:

Provide written notice and allow a processing window

Key milestones from initiation to recurring deposit

Track these sequential stages to confirm authorization is verified, activated, and retained for audit and reconciliation.

01

Form submission

Employee signs and returns the authorization form

02

Verification

Payer verifies account via check or micro-deposit

03

Activation

Payroll schedules first direct deposit after verification

04

Ongoing reconciliation

Periodic review and retention for audit

Common mistakes to avoid when preparing the authorization

Entering an incorrect routing or account number that causes returned payments and reconciliation delays.
Failing to verify account ownership before activating deposits, which can lead to misdirected funds and recovery effort.
Using ambiguous authorization language that lacks clear consent to correct erroneous deposits or to initiate reversals.
Not retaining the signed authorization or audit trail, complicating dispute resolution and compliance reviews.

Risks and consequences of incorrect or incomplete authorizations

Returned payments: Bank fees

Backup withholding: 24% withholding risk

Reconciliation burden: Manual labor costs

Fraud exposure: Unauthorized transfers

Compliance gaps: Audit findings

Legal disputes: Potential claims

Electronic vs paper direct deposit authorization — quick comparison

Compare the core characteristics of electronic and paper authorizations to choose the right method for your workflow.

Criteria	Electronic	Paper
Legal validity	yes (esign/ueta)	yes (handwritten)
Processing speed	faster	slower
Record retention	digital archive	physical file
Revocation method	written or e-notice	written notice

eSignature solution pricing comparison for completing electronic authorizations

Typical starting prices and feature availability for common eSignature vendors. signNow is listed first per marketplace convention; compare features and compliance to your needs.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day free trial	Yes (trial)	Yes (trial)	Yes (trial)	Yes (trial)
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Real-world examples of using e-signed authorizations

These examples show how organizations streamline payments and ensure compliance using online authorization forms and eSignature workflows.

Optica Ventures

Optica automated vendor payments and eliminated paper checks to reduce reconciliation time.

The interface is simple and easy to use for their team.
As COO Brian Fitzgibbons noted, the system is equally easy for customers and helped speed payment cycles while keeping an auditable trail for accounting and compliance.

Xerox NetSuite Operations

Xerox integrated authorization capture with financial systems to improve routing and reconciliation.

Integration enabled consistent signature capture and field mapping.
Kodi-Marie Evans, Director of NetSuite Operations, reported that flexibility and integration let the team put signatures on the right documents in the right formats and streamline payment processing.

Frequently asked questions and troubleshooting

Answers to common questions about validity, verification, revocation, and digital evidence for Direct Deposit Authorization for Electronic Funds Transfer.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are legally binding under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and a retained reproducible record.
Is notarization required?
Not generally. Notarization is uncommon for direct deposit authorizations, but an employer or payer may require notarization or RON for higher-risk transactions; check employer policy and state notary rules.
How do I correct a wrong routing number?
Submit a revised signed authorization promptly and notify payroll or the bank. Corrective debit/credit steps may be needed; bank returns can incur fees and reconciliation work.
How can a payer verify account ownership?
Common methods include a voided check, micro-deposit verification, or bank confirmation. Proper verification reduces misdirected payments and fraud risk.
How do I revoke authorization?
Provide written notice to the payer per the authorization terms; allow the payer reasonable time to process the revocation before stopping deposits to avoid disputes.
What records should be retained?
Retain the signed authorization and audit trail in secure storage per IRS and industry rules; healthcare records are subject to HIPAA retention (45 CFR §164.530(j)).

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