- Your financial institution must be a member of the Automated Clearing House in order for you to take advantage of this option.
- If you decide to Enter the RACE, please complete this Authorization Form. For checking account deposits you only need
to attach a voided check to this RACE form. For saving account deposits this form must be completed by you and your
financial institution. If your account is a joint account, both parties must sign this Authorization Form.
- If you wish to cancel your participation in the RACE, you may do so by completing another Authorization Form.
- It is your responsibility to notify us immediately of any changes in your bank account (e.g., change of account number, bank, closure of account, etc.). Use this Authorization Form as a Change Transaction to notify us of these changes. We will process these changes immediately upon receipt of the form.
- Your electronic transfer will be made directly into your account. If this transfer cannot be completed within three business days, your FSA Administrator will issue and mail a reimbursement check to you. Pending resolution of the electronic transfer problem, you will continue to receive reimbursement checks in the mail.
- If you re-enroll in either the DCAAccount or HCSAccount (or both), your participation in the RACE will automatically continue from one Plan Year to the next, unless you request cancellation.
- If you have been inactive in the NYS Flex Spending Account for a full Plan Year or longer, you must submit a new RACE form to resume direct deposits of your reimbursements.
- The agreement represented by this authorization will remain in effect throughout the Plan Year until you cancel it. To cancel, you must complete a new Authorization Form as a Cancel Transaction.
- This agreement may also be canceled by your financial institution. In such cases, you will receive reimbursement checks in the mail.