Direct Deposit of Employee Pay and/or Employee Travel and Expense Reimbursement (PER-58)
Fill out the Direct Deposit of Employee Pay (PER-58) (pdf)
Instructions for Completing the Form
Return the completed form with attachments to the Division of Human Capital Services, 103 Edwards Hall, 1810 Kerr Drive, Manhattan, KS 66506-4801.
Complete the following fields:
- Department Name - Print your department name (leave blank if unknown.)
- Employee ID - Print your 11-digit employee identification number. (Generally begins with a "W")
- Last four numbers of SSN - Print the last four numbers of your social security number.
- Name - Clearly print your name as it exists on social security card.
Section A: Enrollment or Change Authorization
Complete the following fields:
- Select One - Mark the box next to the requested action: Mark "New Enrollment" if you are completing the direct deposit form for the first time. Mark "Account Change" if you are changing institutions, changing accounts, adding accounts or changing deposit amounts/percentages.
- Effective Date - For new enrollments the effective date will be your first day of employment. For account changes and additions the effective date will be the first day of the pay period you want the change to begin.
- Select One: Mark the box next to the requested direct deposit action: All Accounts, Only Travel and Expense Direct Deposit or Only Payroll Direct Deposit.
Section B: Financial Institution Information
- Clearly print the Name, Branch (or location), and City, State, and Zip code address information for the institution where you would like your funds direct deposited.
- List each financial institution, not just the one(s) you are adding or changing.
Account Distribution Data
- Priority - Enter the priority for the account. Distributions are made to accounts in order of Priority. The lower the priority number, the higher the priority. This is a required field when multiple accounts are chosen. Any flat dollar amounts to be distributed to an account should have the lowest priority number. This will ensure that the flat dollar amounts are deposited first. Percentages of all accounts must equal 100%.
- Transit # - The nine digit ID number of the financial institution. Normally found at the bottom left of the check.
- Account # - Enter the checking or savings account number to where you would like your funds to be deposited.
- %Net Pay/$Amount - Enter either a dollar amount or a percent of net pay to be distributed to the account. Any flat dollar amounts to be distributed to an account should have the lowest priority number. This will ensure that the flat dollar amounts are deposited first.
Mark the Appropriate Boxes:
- Mark the box for the type of bank account, checking or savings
- Mark the box next to the International ACH Bank if the entire amount of your direct deposit to this account may result in the transfer of funds to a financial agency outside of the U.S.
- Mark the box next to Use this account for my travel and expense reimbursements if you want your travel and expense reimbursements deposited to this account. If more than one account is listed you may only select one account for your travel and expense direct deposit. If you are a new enrollment and you do not select an account for your travel and expense reimbursement account, then your travel and reimbursement expenses will be deposited into your priority #1 account.
Note: If multiple accounts are being used, you must complete the financial institution and account distribution information for each account you indicate. Use additional pages as needed. Sign and date each page.
Copies of checks, voided checks or deposit slips for accounts must be attached to the Direct Deposit form for all new enrollments, changes to financial institutions, or additions of new accounts. Changes to amount or percentage only do not require attachments. Missing attachments delay processing.
- Common problems with attachments
- Deposit slip does not contain routing number-Use voided or copied checks when possible.
- Savings account does not have checks or preprinted deposit slips-Ask institution for routing/account statement.
- Attachment account number information does not match the account information on the Direct Deposit form-Use only deposit slips or checks for the account requested. Do not use a check copy to attach for a savings account at the same institution.
Consent by signing and dating the form