Electronic Funds Transfer (EFT) Attestation


All DHHS providers will electronically sign the EFT Attestation as part of the Provider Enrollment Online Application.

I hereby certify that the checking OR savings account indicated on this application is under my direct control and access; therefore, I authorize CSRA, as fiscal agent for the State of North Carolina, to initiate, change or cancel credit entries to the checking or savings account as indicated on this application. This authority is to remain in full force and effect until CSRA has received written notification, from either myself or a verifiable Officer of the Agency, of the account’s termination in such time and in such a manner as to afford CSRA a reasonable opportunity to act upon it.