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DHS-3552-ENG 6-17 Direct deposit for the Minnesota Child Care Assistance Program Child care is an important job. Being paid for doing your job is also important. Getting paid for your work for the Child Care Assistance Program (CCAP) is easier thanks to Electronic Fund Transfer (EFT). What is Electronic Fund Transfer? Direct deposit of your Child Care Assistance Program payments automatically into your bank account is available. This is called Electronic Fund Transfer, or EFT. In most cases, you’ll receive your money faster by using this service. You won’t have to wait for a check to arrive in the mail. Why should I use EFT? This method is safe, reliable and easy to use. You won’t have to make a deposit at the bank, or worry about lost or stolen checks. With Electronic Fund Transfer, you’ll receive your money safely and quickly. This service not only saves you time and effort, it also saves tax dollars, costing the state less money than printing and mailing checks. How will I know how much money has been deposited into my account? You will be mailed a remittance advice that details what you’ve been paid each billing cycle. The remittance advice lists children in your care, payment IDs and the amount paid for each child. How will my privacy be protected? You may have more privacy with Electronic Fund Transfer. Checks contain a lot of personal information. With Electronic Fund Transfer, the information passes electronically from the Minnesota Department of Human Services to your bank. The information sent is protected by – an electronic scrambling of data and other security procedures—to ensure your information stays private. How often will I be paid? You can choose to bill the county in either a two- week or four-week billing cycle. Contact the Child Care Assistance Program agency listed on the following page for more information. How do I sign-up? Signing up for Electronic Fund Transfer is easy. Fill out the authorization form and return it to the Child Care Assistance Program agency listed on the following page. Include a voided check or a letter from your bank that includes their routing number and your account number. ---PAGE BREAK--- Where do I return this form? Provider Information NAME OF PROVIDER CCAP PROVIDER ID LICENSE NUMBER (IF APPLICABLE) Account Holder Name LAST NAME FIRST NAME MIDDLE NAME Account Information NAME OF BANK/CREDIT UNION ACCOUNT TYPE: L Checking L Savings Routing Number (nine digits) l l l l l l l l l Account Number (up to 17 digits) l l l l l l l l l l l l l l l l l (Include a voided check or letter from your bank that includes their routing number and your account number.) NAME (PRINT) TITLE ACCOUNT HOLDER SIGNATURE DATE ■ ■I am an authorized signer on this bank account. ■ ■I am fully authorized to sign this document, and if I am a licensed child care provider, I attest and represent that I am an owner, license holder, or controlling individual as defined in Minnesota Statutes, section 245A.02. ■ ■I authorize the Minnesota Department of Human Services (DHS) to make deposits to the account listed above. DHS may make deposits to this account until I cancel this authorization and DHS has had time to act on it. If funds are mistakenly deposited into my account, I authorize DHS to deduct the amount of error from my account or from my future payments. SIGN Clear Form ---PAGE BREAK--- Image of the Minnesota Department of Human Services language block. Attention. If you need free help interp reting this document, ask your worker or call the number below for your language. Arabic 1-[PHONE REDACTED]. Khmer 1-[PHONE REDACTED]. Serbo-Croatian/Bosnian 1-[PHONE REDACTED]. Hmong 1-[PHONE REDACTED]. Lao 1-[PHONE REDACTED]. Oromo 1-[PHONE REDACTED].ADA Advisory icon For accessible formats of this publication or additional equal access to human services, write to [EMAIL REDACTED], call [PHONE REDACTED], or use your preferred relay service. (ADA1 [9-15])