In-Home Supportive Services (IHSS) Direct Deposit Form

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The In-Home Supportive Services (IHSS) Direct Deposit Form is a document which allows an IHSS provider, that is someone who is paid to aid individuals who receive in-home supportive services, to receive funds directly into their checking or savings account. This is presented as an alternative to receiving paychecks in the mail and it comes with myriad benefits. The information required is very minimal and the document, once completed, should be sent to the Provider Enrollment Processing Center in Roseville, California.

How to Write

Step 1 – Begin by downloading the fillable document in Adobe PDF.

 

Step 2 – Next, fill in the fields asking for the name and address of the provider (presumably you). Select the box that indicates the purpose of the form, either authorizing direct deposit, changing the direct deposit information, or cancelling the direct deposit.

Step 3 – The second half of the form will ask for the case number, the provider number and the type of bank account the funds will be deposited into. Below this you must enter the routing number (9 digits), the account number, and the name of the bank. Finally, you can add the day’s date, print off the form and sign the bottom. As previously stated, the completed direct deposit form should be sent to the below address:

PROVIDER ENROLLMENT PROCESSING CENTER
P.O. BOX 1120
ROSEVILLE, CA 95678