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Staff Manual Guide 2310.3, Attachment C

 

NON-RECEIPT OF DIRECT DEPOSIT

In the event of a non-receipt of direct deposit, the following information must be received by the employee:

1. Employee's Name:______________________________________________________

Signature:______________________________________________________________

 

2. Employee's Address:____________________________________________________

_______________________________________________________________________

_______________________________________________________________________

 

3. Social Security No.:_____________________________________________________

 

4. Bank Name:___________________________________________________________

& Address:______________________________________________________________

_______________________________________________________________________

 

5. Bank Contact Person:___________________________________________________

Signature:_______________________________________________________________

Phone No.:______________________________________________________________

 

6. Account Number:______________________________________________________

 

7. Routing Number:______________________________________________________

 

8. Type of Account:______________________________________________________

 

9. Amount of Check:______________________________________________________

 

10. Pay Date:____________________________________________________________