Direct Deposit Enrollment Request For State Employees

State employee requests direct deposit enrollment, changes or cancellations.

Download the Form

A Copy of Your UB Card is Required

As an added measure of security, we require that you submit a copy of your official UB Card with your direct deposit request form. 

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Completing the Form

  1. Read through all pages of the document to find specific instructions, if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form and a copy of your UB Card to:         

Human Resources
120 Crofts Hall
North Campus

Need Help Completing the Form?

Contact a Payroll Expert

Faculty, Staff, TA/GA, Hourly Non-Student and Student Assistant Payroll

If Last Name Starts A - CH

Elaine Hines.

Elaine Hines

State Payroll Services

Phone: 716-645-4425


If Last Name Starts D-Gi

Kathy Pohlman.

Kathy Pohlman

State Payroll Services

Phone: 716-645-5202


If Last Name Starts GL - K

Roseann Brzozowiec.

Roseann Brzozowiec

State Payroll Services

Phone: 716-645-4449


If Last Name Starts L - NORD

Kathleen Sears.

Kathleen Sears

State Payroll Services

Phone: 716-645-4450


If Last Name Starts NORE - SHEO

Cheryl Delano.

Cheryl Delano

State Payroll Services

Phone: 716-645-4446


If Last Name Starts SHEP - YH

Joanne Intorre.

Joanne Intorre

State Payroll Services

Phone: 716-645-4424


If Last Name Starts Ci-Cz and Yi-Z

Melissa Barone.

Melissa Barone

State Payroll Services

Phone: 716-645-4445


Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: November 2012

Owner: Human Resources