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Name: Fillable Online Direct Deposit Authorization for Allegiance Benefit Plan Management Fax Email Print - pdfFiller
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This form allows participants to authorize Allegiance Benefit Plan Management, Inc. to deposit and debit funds related to their employer-sponsored flexible spending plan into their bank account.

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How to fill out direct deposit authorization form

How to fill out Direct Deposit Authorization Form for Flexible Spending Plan

01

Obtain the Direct Deposit Authorization Form for the Flexible Spending Plan from your HR or benefits office.

02

Fill in your personal information at the top of the form, including your name, address, and Social Security number.

03

Provide your bank account details: account number, routing number, and the type of account (checking or savings).

04

Indicate the amount you wish to be deposited directly to your account.

05

Sign and date the form to authorize the direct deposit.

06

Submit the completed form to your HR or benefits office for processing.

Who needs Direct Deposit Authorization Form for Flexible Spending Plan?

01

Employees participating in a Flexible Spending Plan who want their reimbursements or contributions deposited directly into their bank accounts.

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What is Direct Deposit Authorization Form for Flexible Spending Plan?

The Direct Deposit Authorization Form for Flexible Spending Plan is a document that enables participants to authorize automatic deposits of reimbursements and benefits into their bank accounts for expenses covered under a flexible spending account (FSA).

Who is required to file Direct Deposit Authorization Form for Flexible Spending Plan?

Individuals participating in a flexible spending plan who wish to receive their reimbursements via direct deposit are required to file the Direct Deposit Authorization Form.

How to fill out Direct Deposit Authorization Form for Flexible Spending Plan?

To fill out the form, participants need to provide their bank account information, including the account number, routing number, and the account type (checking or savings). They must also sign and date the form to confirm their authorization.

What is the purpose of Direct Deposit Authorization Form for Flexible Spending Plan?

The purpose of the form is to streamline the reimbursement process by allowing funds to be directly deposited into participants' bank accounts, thereby reducing the time it takes to receive reimbursements.

What information must be reported on Direct Deposit Authorization Form for Flexible Spending Plan?

The form must include the participant's name, contact information, bank account number, routing number, type of account (checking or savings), and a signature authorizing the direct deposit.

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