Authorization Number : 855-0534
Agency Series No. : FD-32
Status : Active
Agency Web Link :
Agency : BWC
Confidential Description : Records contain social security numbers, claim numbers, provider numbers, and bank numbers
Division : BWCFDAD
Vital Description :
Section : BWCFDADBPAY
Record Title : EFT and EBT Authorization Forms
Revision : 5
Record Description : The Electronic Fund Transfer (EFT) and Electronic Benefit Transfer (EBT) Authorization Forms are used for benefit recipients and vendors that are paid from the State Insurance Fund (SIF). These forms give BWC authorization to send a benefit recipient’s / vendors payments electronically to the financial institution indicated. The EFT and EBT forms are scanned into the Warrant UDS System