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INSTRUCTIONS: ARKANSAS RELIACARD ENROLLMENT AUTHORIZATION FORM

The ReliaCard is a prepaid Visa card which is used to receive Arkansas child support payments via direct deposit. The document to enroll in this program can be obtained from the website maintained by the Arkansas Department of Finance and Administration. Further assistance can be obtained by calling the phone number given on the form.

Arkansas ReliaCard Enrollment Authorization Form Step 1: On the first blank line, enter the name of the custodial parent.

Arkansas ReliaCard Enrollment Authorization Form Step 2: On the second blank line, enter the Social Security number of the custodial parent.

Arkansas ReliaCard Enrollment Authorization Form Step 3: On the third blank line, enter the date of birth of the custodial parent.

Arkansas ReliaCard Enrollment Authorization Form Step 4: On the fourth blank line, enter the phone number of the custodial parent, including the area code.

Arkansas ReliaCard Enrollment Authorization Form Step 5: On the fifth blank line, enter your case number or numbers.

Arkansas ReliaCard Enrollment Authorization Form Step 6: On the sixth blank line, enter your current street mailing address.

Arkansas ReliaCard Enrollment Authorization Form Step 7: On the seventh blank line, enter your city.

Arkansas ReliaCard Enrollment Authorization Form Step 8: On the eighth blank line, enter your state.

Arkansas ReliaCard Enrollment Authorization Form Step 9: On the ninth blank line, enter your zip code.

Arkansas ReliaCard Enrollment Authorization Form Step 10: On the tenth blank line, enter the maiden name of the mother.

Arkansas ReliaCard Enrollment Authorization Form Step 11: On the eleventh blank line, enter your signature.

Arkansas ReliaCard Enrollment Authorization Form Step 12: On the twelfth blank line, enter the date.

Arkansas ReliaCard Enrollment Authorization Form Step 13: Separate the authorization form from the instructions by cutting along the dotted line where indicated.

Arkansas ReliaCard Enrollment Authorization Form Step 14: Mail the form to the address printed on the instructional top half of the page.

Arkansas ReliaCard Enrollment Authorization Form Step 15: You should expect to receive your ReliaCard in the mail within 7 to 10 business days. Once you have received this card, you will need to activate it by calling the phone number given on the back of the card.

Arkansas ReliaCard Enrollment Authorization Form Step 16: Once your ReliaCard has been activated, you can expect to have direct deposits automatically added to your account.