Temporary Disability Insurance Direct Deposit Information, RI DLT

The following form authorizes Temporary Disability Insurance to directly deposit your benefit payment into a savings or checking account. It is in pdf format.

You must have Adobe Reader to view it.

Please print out the form, fill it in, attach check marked "void" or bank documentation
of routing and account numbers and mail everything to:

Temporary Disability Insurance
P.O. Box 20100
Cranston, RI 02920

Direct Deposit Authorization Form

Use this check to find your bank's routing number and your account number.

THIS IS NOT A REAL CHECK!


	RI Department of Labor and Training Temporary Disability Insurance P.O. Box 20100, Cranston, RI 02920-0941	Phone: (401) 462-8420 Fax (401) 462-8466 TTY via RI Relay: 711 2/13/13 MDF
	DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request