Delaware Health and Social Services Division of Child Support Enforcement 
P.O. Box 12327 Wilmington, DE 19850 
Telephone: (302) 577-7171 in New Castle, (302) 739-8299 in Kent, (302) 856-5386 in Sussex 


DIRECT DEPOSIT AUTHORIZATION APPLICATION 

Please complete, provide only the last four numbers of your Social Security Number (SSN).

Return application by mail to:  DCSE, P.O. Box 12327 Wilmington, DE 19850 


Your Name as it appears on the Bank Account: ___________________________________________

SSN: XXX-XX-________

Child Support Case Number(s): __________________________________________________________

Home Address: __________________________________________________________

Daytime Phone Number: __________________________________________________________________

Email Address:  ________________________________________________________________________

Name of Financial Institution: __________________________________________________________

Account type: 	____ Checking  or  ____ Savings  
 
Bank Routing Number:  __________________________________________________________

Bank Account Number:  __________________________________________________________

Please provide the name(s) of other account holders having access to this account:   

__________________________________________________________________________________________
 
I authorize the Division of Child Support Enforcement (DCSE) to deposit my child support 
payments directly into my checking or savings account.  I authorize DCSE to adjust any 
over/under deposit it has made to my checking or savings account. I understand that DCSE 
will make a reasonable effort to notify me within one business day of when an adjustment 
is made.  I understand the deposit/adjustments will be made electronically by ACH 
transactions and I must allow the Federal Reserve two business days from the disbursement 
date to have the funds available to my financial institution.  I also understand the 
following:  It is my responsibility to provide correct routing and account information 
for ACH transmissions by attaching a voided check, verified deposit slip or financial
institution printout to this authorization. I will immediately notify DCSE if my banking 
information changes.  I must include my name, social security number, and case number on 
all correspondence regarding direct deposit. I must submit a new authorization form to 
change my direct deposit. I understand that DCSE will verify my bank account information 
and I will receive my child support payment via paper check during the verification process.  
I can stop my direct deposit by submitting this same form and writing “cancel” at the top.  
If there is an urgent need to submit a cancellation request, please contact Customer Service 
for additional instructions. I must notify DCSE of any changes to my address.  I authorize 
DCSE to update my mailing address on DCSE records to be the same as the Home Address provided
 on this form. The Customer Service Automated Assistance Line (AAL) will provide the date 
DCSE disbursed my payment; I must verify with my financial institution when the payment is 
posted to my account and funds are available for withdrawal. By signing below I affirm that
I have read and agree to all of the conditions listed above. 

Signature__________________________________________________________

Date ______________________