OhioBWC - Worker - Form:  (ACT Enrollment and Direct Deposit)

ACT Enrollment and Direct Deposit Authorization
(A-12)

Introduction
Injured workers receiving disability benefits, excluding death and temporary partial, are eligible for direct deposit and should use this form to apply for it. Automatic Comp Transfer (ACT) deposits your workers' compensation payments into a checking or savings account of your choice on the day payment is due.
Note: If you're already receiving benefits through direct deposit, also known as electronic funds transfer, do not use this form. Use the Direct Deposit ACT Change (A-35) to make any changes in your direct deposit.


Required information
  • Bank routing number
  • Bank account number
  • Bank account type (checking or savings)
  • Name on account

If you have all the required information on hand, simply click the start button to begin.

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