Direct Deposit Authorization Form

DIRECT DEPOSIT AUTHORIZATION FORM. This Kentucky Education and Labor Cabinet form authorizes direct deposit of workers’ compensation payments into a claimant’s designated checking or savings account. Issued by the Department of Workers’ Claims, Division of Workers’ Compensation Funds – Special Fund, it requires the claimant’s identifying details, bank information, and account type. A voided check must be attached, and the form must be notarized before submission. Claimants provide their routing and account numbers, then mail or fax the completed form to the Department’s Frankfort, KY office. www.FormsWorkflow.com