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
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http://www.nyc.gov/html/acs/html/support_families/post_adoption.shtml |
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Submit Completed Form To: TheCityofNewYork |
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ChildrenʼsServices |
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For Use By: |
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P. O. Box914 |
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AdoptionSubsidy |
DirectFosterCare |
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PeckSlipStation |
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HousingSubsidy |
AdoptionAttorney |
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Type of Action |
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Attach a voided check or most recent savings statement. Check all that apply: |
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NewEnrollment |
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ChangeOfNameOnAccount |
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ChangeOfAccountType |
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Cancellation |
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ChangeOfAccountNumber |
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ChangeOfABANumber |
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V E N D O R / C L I E N T S E C T I O N |
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Vendor/Client Identification |
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First |
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M.I. |
Last |
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Vendor/ClientNumber |
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TaxID/SSN(LandlordOnly) |
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DaytimeTelephoneNumber |
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– |
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– |
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Enrollment (Person(s)namedontheaccountmustincludevendor/client – exceptionmayapplytolandlord)
Person(s)NamedOnAccount(Print Exactly – Includetrusteeorjointowner)
Person1
Person2
ABANumber* |
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AccountNumber** |
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AccountType |
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(CheckOnlyOne) |
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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: ________________________________________________________ |
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Cancellation
IHerebyAuthorizeNYC/ACSToCancelMyDirectDepositAgreement.
Vendor/ClientSignature: ________________________________________________________ |
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A G E N C Y U S E O N L Y |
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DataEntry: _______________________________________/_______________________________ |
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SIGN |
DATE |
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Supervisor: _______________________________________/_______________________________ |
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SIGN |
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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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