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Fillable Nyc Cm 623 Form in PDF

The NYC CM 623 form is a crucial document for individuals seeking to enroll in or cancel their direct deposit with the City of New York's Administration for Children's Services (ACS). This form allows vendors and clients to manage their payment preferences, ensuring that funds are deposited directly into their checking or savings accounts. Understanding how to properly complete and submit this form can simplify financial transactions related to adoption subsidies and foster care payments.

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Article Guide

The NYC CM 623 form plays a crucial role in facilitating direct deposit services for vendors and clients involved with various programs under the city's Administration for Children's Services (ACS). This form allows individuals to enroll in direct deposit for payments related to adoption subsidies, foster care, and housing subsidies. It also provides options for changing account details or canceling existing arrangements. Essential information required includes personal identification details, such as name, vendor/client number, and contact information, along with banking specifics like account and ABA numbers. The form ensures that funds are deposited directly into the designated checking or savings account, streamlining the payment process. Furthermore, it includes a section for authorization, where individuals can grant ACS permission to manage their deposits and any necessary reversals in case of errors. Completing this form accurately is vital for maintaining uninterrupted financial support and ensuring compliance with the agency's operational guidelines.

Preview - Nyc Cm 623 Form

CM 623

REV. 12/08

Vendor/Client Direct Deposit

Enrollment / Cancellation

http://www.nyc.gov/html/acs/html/support_families/post_adoption.shtml

Submit Completed Form To: TheCityofNewYork

ChildrenʼsServices

For Use By:

P. O. Box914

AdoptionSubsidy

DirectFosterCare

PeckSlipStation

HousingSubsidy

AdoptionAttorney

NewYork,NY10272-0914

Type of Action

Attach a voided check or most recent savings statement. Check all that apply:

NewEnrollment

ChangeOfNameOnAccount

ChangeOfAccountType

Cancellation

ChangeOfAccountNumber

ChangeOfABANumber

V E N D O R / C L I E N T S E C T I O N

Vendor/Client Identification

First

M.I.

Last

Vendor/ClientNumber

TaxID/SSN(LandlordOnly)

DaytimeTelephoneNumber

–

Enrollment (Person(s)namedontheaccountmustincludevendor/client – exceptionmayapplytolandlord)

Person(s)NamedOnAccount(Print Exactly – Includetrusteeorjointowner)

Person1

Person2

ABANumber*

AccountNumber**

AccountType

(CheckOnlyOne)

Savings Checking

*ABABankNumber: Checking Accounts – TheABANumberisthefirstnine(9)numberspriortotheaccountnumberatthe bottom left corner of the check. Savings Accounts – Contact Your Bank For ABANumber, If Not Known.

**AccountNumber:See check, passbook or account statement for account number.

Vendor/Client Authorization

I hereby authorize NYC/ACS to deposit my payment directly into my checking or savings account as requested. I also grantauthorizationforthereversalofacredittomyaccountintheeventthecreditwasmadeinerror. Iunderstandthat, under the "NationalAutomated Clearing HouseAssociation" operating guidelines and rules, NYC/ACS canreverseonly the amount of the incorrect direct deposit. I agree that this authorization will remain in effect until I provide NYC/ACS a writtencancellationtoterminatetheservice.

Vendor/ClientSignature: ________________________________________________________	________/________/________
	DATE

Cancellation

IHerebyAuthorizeNYC/ACSToCancelMyDirectDepositAgreement.

Vendor/ClientSignature: ________________________________________________________		________/________/________
		DATE

	A G E N C Y U S E O N L Y

DataEntry: _______________________________________/_______________________________		________/________/________
PRINT	SIGN	DATE
Supervisor: _______________________________________/_______________________________		________/________/________
PRINT	SIGN	DATE

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Form Characteristics

Fact Name	Description
Form Purpose	The NYC CM 623 form is used for enrolling in or canceling direct deposit services for various subsidies, including adoption and foster care payments.
Governing Agency	This form is managed by the New York City Administration for Children's Services (ACS).
Submission Address	Completed forms must be submitted to the NYC ACS at P.O. Box 914, Peck Slip Station, New York, NY 10272-0914.
Required Documentation	Applicants must attach a voided check or the most recent savings statement to the form.
Action Types	Users can select from several actions: New Enrollment, Change of Name on Account, Change of Account Type, Cancellation, Change of Account Number, and Change of ABA Number.
Authorization Clause	By signing the form, the vendor/client authorizes NYC/ACS to deposit payments directly into their specified account and allows for reversals in case of errors.
Account Information	Applicants must provide their ABA number and account number, which can be found on their checks or account statements.
Cancellation Process	To cancel the direct deposit agreement, a written request must be submitted to NYC/ACS, which can be done using the same form.

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