PAYMENT INSTRUCTIONS for CIVIL PENALTY of EXECUTIVE ORDER 13F

(Executive Order 13F – Vaccine Mandate)

Below are instructions for making payment to the Connecticut Department of Public Health (DPH).

1.  ACH remittance should be made using the banking information below:

  Bank Name: Bank of America

  Address: 175 Addison Road, Windsor, CT 06095

  Contact: Anna Maria Piccione

  Account Name: State of Connecticut Regular Account

  Account #: 0000054763

  ABA Routing #: 011900254

  Memo/Reference: DPH+Provide the Civil Penalty Number

    2. Check payments should be made using the information below:

    Payable to: Treasurer, State of Connecticut

  P.O. Box 340308

  Hartford, CT 06134-0308

  Attention: Fiscal Office, MS#13APR

  Memo/Reference: Provide the Civil Penalty Number

Please note: YOU MUST INCLUDE THE CIVIL PENALTY NUMBER ON THE REMITTANCE ADVICE

Important Note: Failure to include the civil penalty number may result in delay or inability of the State to recognize

your payment pursuant to the collection of this fine.