Direct Deposit via electronic funds transfer (EFT) is a fast and safe way to receive payment from PCG Public Partnerships, LLC (PPL) for the services you provide to Virginia consumers.

Use this form to allow PPL to deposit your pay directly into your existing:

·  Checking account,

·  Savings account or

·  Debit Card account.

Also use this form to notify PPL of changes to a Direct Deposit Account that you already set up for payment by this Employer. You can:

·  Change your bank

·  Change your account number or type of account

·  Cancel an existing PPL EFT set-up.

F  NOTE: If you prefer to have your pay deposited to a new Money Network® Account, fill out the Money Network Account Form found in your Enrollment Forms Packet.

F  NOTE: If you do not sign up for Direct Deposit or fill out the Money Network Account Form, PPL will create a Money Network Account to deposit your pay via EFT, and will provide you with a Money Network Debit Card and Checks so you can access the funds.

To complete the Direct Deposit Account Form, please follow the instructions below:

SECTION 1: Specify a new PPL EFT set-up or change or cancel an existing set-up.

Check the appropriate box, as follows:

·  To deposit your pay directly into your existing account, check the box next to “New Direct Deposit Set-up.”

·  To notify PPL to transfer funds to a different account of the same type (for example, to a different checking account you own) at the same financial institution, check the box next to “Change Account Number.”

·  To notify PPL to transfer funds to a different type of account (for example, switching from your checking to your savings account) within the same financial institution, check the box next to “Change Account Type.”

·  To notify PPL to transfer funds to a different financial institution (bank, credit union, etc.) than the one you previously had set up for EFT with PPL, check the box next to “Change Financial Institution.”

·  To cancel your existing PPL EFT account, check the box next to “Cancel Existing PPL Setup.” If you cancel without setting up a new EFT account, PPL will create a Money Network Account to deposit your pay via EFT.

SECTION 2: Payee Information

Item 1: Leave this line blank.

Item 2: Print your 9-digit Social Security Number (SSN) in the boxes provided. Double-check your number to ensure accuracy.

Items 3-8: In the blanks provided, print your full name, your full address and your telephone number, unless they are prefilled. If these items are prefilled with incorrect information, contact PPL Customer Service toll-free at 1-866-259-3009.

F  IMPORTANT: If this is a new address not already prefilled on the form, you must notify PPL immediately. To meet this requirement, you can update your contact details on the PPL Web Portal (see the FAQ page 6 in the Welcome Packet); or fax or mail a Change of Address form (Page 16 of the Welcome Packet). Failure to comply may result in a delay of payment.

SECTION 3: Signature

Items 9-11: Once you have completed ALL sections, sign and date in the blanks provided. You can leave Item 10 (Title) blank.

SECTION 4: Account Information

All items in this section must be completed.

Item 12: Write the formal name of the financial institution (bank, credit union, etc.) to which you want your pay deposited.

Item 13: Write the number and street address of the institution you named in Item 12.

Items 14-16: Provide the town, state and ZIP code of the financial institution named in Item 12.

Item 17: Check the box associated with the type of account to which you want your pay deposited at the institution you named in Item 12.

F  IMPORTANT: To have PPL deposit funds to your account, you must attach, where indicated, one of the following account documents to this Direct Deposit Account Form:

·  Direct Deposit to a checking account: Submit either a voided check or a letter from your bank that shows your account number and routing number. (You can submit a copy of a voided check only if the routing and account number are clear and readable.)

·  Direct Deposit to a savings account: Submit either a pre-printed deposit slip or letter from your bank that shows your name and account number, and bank routing number.

·  Direct Deposit to your existing Debit Card: Submit a letter from the debit card company with your account number and routing number.

Item 18: Provide the Routing Number of the institution you named in Item 12. (Contact the institution for this information if you are unsure.)

Item 19: Write the account number of the account to which you want your pay deposited.

SECTION 5: Cancel an Existing PPL EFT Account

Fill in Sections 2, 3 and 4. In Section 5, please state the reason you are cancelling your existing PPL direct deposit account. If you cancel without setting up a new EFT account, PPL will create a Money Network Account to deposit your pay via EFT.

The Direct Deposit Account Form and the supporting documents must be submitted to PPL by:

Fax: 1-866-709-3319

or

Mail: Public Partnerships, LLC

Attn: Virginia Consumer Directed Services Program

4991 Lake Brook Drive, Suite 190

Glen Allen, VA 23060

PPL Review

PPL will verify your account number with your bank. This can take one to two pay cycles from the date PPL receives your completed and signed Direct Deposit Account Form. Until then, PPL will mail paper checks.

F NOTE: If there is a difference in account details when PPL verifies with your bank, PPL will mail paper checks to your address temporarily. It may take an additional one to two pay cycles to verify your account and to set up Direct Deposit. Once the account details have been confirmed, PPL will deposit your wages directly to your bank account or debit card.

The Direct Deposit payment is made on your payday. Depending on your bank’s internal processing, it can take 24 to 48 hours for the funds to appear in your account, not including bank holidays.

PPL Web Portal check box:

Once Direct Deposit starts, pay stubs of each pay period showing your gross wages, tax and other withholdings, and personal information will be available to you by logging into the PPL Web Portal.

PPL also can mail pay stubs to you upon request. To request pay stubs by mail, check the box located at the very bottom of the Direct Deposit Account Form.