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Payment Services Forms (Alphabetical)

Name Number Description
ACH (Direct Deposit) Payment Destination Confirmation (login required) PDF
Used by agencies who must require payees to confirm whether their state payments are destined to be forwarded outside of the U.S.
Agency Authorization for Warrant Pickup (login required) PDF
Used by agencies to authorize personnel to pick up warrants.
Application for Texas Identification Number (login required) PDF
Used by agencies to obtain necessary information from payees to set up a Texas Identification Number (TIN).
Application to Report Indebtedness (login required) PDF
Used by agencies requesting to report state debts or change existing hold agency information.
Bailment Contract (login required) PDF
Used as an agreement between a state agency and the Comptroller’s office that allows the agency to receive post-dated payroll warrants before payday
Debtor Hold File Extract Request (login required)
Used by agencies to request the daily debtor hold extract file.
Direct Deposit Authorization Form (login required) PDF
Used by agencies to provide to payees who wish to receive state payments by direct deposit or change/cancel existing direct deposit information.
Direct Deposit Payment Trace Number Request (login required) PDF
Used by agencies to request an ACH trace number for a state direct deposit payment.
Direct Deposit Reversal Request (login required) PDF
Used by agencies to request an erroneous direct deposit payment be reversed through the Automated Clearing House (ACH) system.
Employee PayCard Authorization (login required)PDF
This form is used by employees to sign up to receive payroll payments through the Employee PayCard program.
Hold Transaction (login required) PDF
Used by a hold source agency to set up, change or release hold information for a state debtor.
Payee Change Request (login required) PDF
Used by agencies requesting updates to payee information in the Texas Identification Number System (TINS); may be provided by the agencies to their payees.
Payment Cancellation Voucher (login required) PDF
Used by agencies to request cancellations of forged warrants that are reinstated or for post-dated payroll deduction warrants.
Reclamation Request for ACH Transactions (login required) PDF
Used by a agencies upon notification of a payee’s death to reclaim a pension, annuity or benefit payment made by direct deposit for which the payee or its estate was not entitled.
Summary Number Application (login required) PDF
Used by agencies to apply for a special payee identification number for low dollar, one-time payments to multiple payees.
Tax Refund Direct Deposit Authorization (login required) PDF
Used by the Comptroller’s Revenue Accounting Division to provide to taxpayers who wish to receive tax refund payments by direct deposit.
Warrant Release or Reinstatement Request (login required) PDF
Used by a hold source agency to authorize the release of a held warrant.