Illinois Direct Deposit Form 1 - Free Download
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State of Illinois
Department of Employment Security
Direct Deposit Form (Authorization / Modification / Cancellation)
FORM MUST BE COMPLETED IN INK
Last Name: First Name: MI:
Social Security #:
Claimant Signature: Date: / /
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
INSTRUCTIONS: If you are applying for Direct Deposit or changing your bank information and want to continue with Direct
Deposit and you are enclosing a voided personal check, check the appropriate box in Section A only and sign above. If you
are not enclosing a voided personal check, check the appropriate box in Section A, sign above, and then have a
representative of your financial institution complete Section B before you return this application to us. If you are discontinuing
Direct Deposit, you only need to check the box in Section C and sign above on this form to cancel.
Mail or Fax the completed application to:
Illinois Department of Employment Security Banking Services at (312) 793-1231
P.O. Box 804600
Chicago, IL 60680
Section A: Authorization or Modification of Direct Deposit
I authorize the Illinois Department of Employment Security (IDES) to pay my Unemployment Insurance (UI) or Trade
Readjustment Allowance (TRA) benefits by DIRECT DEPOSIT via credit entries, to the account shown on the attached
Personal Original Voided Check. (I understand that my name must be preprinted on the check, and that the check
should not be stapled or taped to this form), OR, in the event I am not enclosing a check, to my account identified in
Section B below. (I understand that I must have a representative of my bank complete Section B if I am not attaching
a voided personal check with my name preprinted on it). I understand that I will be issued Debit Card Payments until my
Direct Deposit request is processed. I acknowledge that by signing this Authorization form, I am agreeing to the terms
and conditions of the Authorization Statements that accompany this form. Further, I authorize IDES to correct any
erroneous credit entries via debit entries as necessary.
Check here if you are already authorized for Direct Deposit and want your benefits to be deposited into a different
financial institution and/or account.
IF YOU ARE NOT ENCLOSING A VOIDED CHECK THE FOLLOWING SECTION MUST BE COMPLETED BY A
REPRESENTATIVE OF YOUR FINANCIAL INSTITUTION BEFORE YOU SUBMIT THIS APPLICATION TO IDES
Section B: Bank Information (To be completed by Financial Institution if you are not enclosing a Personal Check)
Bank or Financial Institution: For Savings Account Please Check the Box
Routing Number: Account Number:
I, representing the financial institution, confirm the identity of the account holder, routing number, and the account number.
Bank Representative: (Print) Telephone #: ( ) -
Signature of Bank Representative: Date: / /
Section C: Cancellation of Direct Deposit (Check Box if you are cancelling Direct Deposit)
Last four digits of the financial institutions account being used for Direct Deposit:
I hereby request that all Unemployment Benefit Payments being made to me by Direct Deposit be stopped and that any
future payments be made by Debit Card. I understand that a benefit payment made to me after I have closed the
account will still be sent to that account if I closed it before IDES had the opportunity to comply with this request, and
that, in such case, the financial institution where I held the old account may return that payment to IDES, and any such
payment will automatically be reissued by debit card.
BPP001F Page 1 of 2 Rev. (09/2011)