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HUMBOLDT STATE
UNIVERSITY
INSTRUCTIONALLY
RELATED
ACTIVITIES
2017-18
Budget, Policies, and Procedures
Table of Contents
HSU ADMINSTRATION APPROVAL MEMO ................................................................................. 1
INSTRUCTIONALLY RELATED ACTIVITIES 2017-18 FISCAL YEAR APPROVED BUDGET ..... 3
INSTRUCTIONALLY RELATED ACTIVITIES FUNDING GUIDELINES ...................................... 10
GENERAL REQUIREMENTS ....................................................................................................... 10
EVALUATION CRITERIA ............................................................................................................. 11
DEFINITIONS ............................................................................................................................... 12
TRANSPORTATION ..................................................................................................................... 12
PER DIEM ..................................................................................................................................... 12
SUPPLIES AND SERVICES ......................................................................................................... 12
REGISTRATION ........................................................................................................................... 12
PUBLICITY .................................................................................................................................... 12
TRAVEL ........................................................................................................................................ 12
PROCEDURES FOR INSTRUCTIONALLY RELATED ACTIVITIES ........................................... 13
BUDGETED AREAS ..................................................................................................................... 13
EXPENDITURES .......................................................................................................................... 13
GENERAL GUIDELINES .............................................................................................................. 13
ACCEPTABLE DOCUMENTATION .............................................................................................. 14
UNACCEPTABLE DOCUMENTATION ......................................................................................... 14
SALES OR ‘USE’ TAX .................................................................................................................. 15
PAYMENT REQUEST .................................................................................................................. 15
PAYMENT REQUEST REQUIREMENTS ..................................................................................... 15
REIMBURSEMENT REQUIREMENTS ......................................................................................... 16
I.R.A. FUND DEPOSIT ................................................................................................................. 17
DEPOSIT FORMS ......................................................................................................................... 17
DEPOSIT INSTRUCTIONS ........................................................................................................... 17
PURCHASE ORDER REQUESTS ............................................................................................... 18
TRAVEL ........................................................................................................................................ 18
I.R.A. TRAVEL REIMBURSEMENT REQUIREMENTS ................................................................ 19
IRA STUDENT TRAVEL VERIFICATION FORM .......................................................................... 20
IRA TRAVEL/PERSONAL EXPENSE REPORT ........................................................................... 21
PAYEE DATA RECORD STD 204 ................................................................................................ 22
PAYMENT REQUEST ................................................................................................................... 24
PURCHASE ORDER .................................................................................................................... 25
RETURN OF ASB FUNDS ............................................................................................................ 26
SIGNATURE AUTHORITY FORM ................................................................................................ 27
1
2
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
1 Art Galleries TO140 D40004 P0054 $55,120 $60,080 $55,000
660003 - SUPPLIES AND SERVICES $55,000
BUDGET LANGUAGE: TOTAL $55,000
2 Broadcast News TO140 D40004 P0063 $1,500 $1,500 $1,500
660003 - SUPPLIES AND SERVICES $1,500
BUDGET LANGUAGE: TOTAL $1,500
3 CCAT TO140 D40004 P5106 $7,400 $7,400 $7,400
660003 - SUPPLIES AND SERVICES $7,400
BUDGET LANGUAGE: TOTAL $7,400
4 CHECK IT TO140 D40067 P0114 $12,035 $14,845 $14,845
660017 - ADVERTISING & PROMO PUBLICTION $8,275
660003 - SUPPLIES AND SERVICES $6,570
BUDGET LANGUAGE: TOTAL $14,845
5 Contingency TO140 D40004 P0075 $10,276 $0 $10,000
660932 - OE-UNALLOCATED O.E.+E. $10,000
BUDGET LANGUAGE: TOTAL $10,000
6 Child Dev Lab $0 $2,660 $0
7 Child Dev Policy & Advocacy TO140 D40004 P0107 $0 $2,422 $2,422606001 - TRAVEL IN STATE $2,422
BUDGET LANGUAGE: TOTAL $2,422
8 Children's Center $0 $30,000 $0
9 El Lenador TO140 D40004 P0108 $0 $5,500 $5,500
660802 - PUBLICATIONS $5,500
BUDGET LANGUAGE: TOTAL $5,500
Committee voted to not fund this request.
Committee voted to not fund this request.
Funds for supplies and services for course productions.
Funds for supplies and services for course projects.
Funds will be used to promote and provide outreach for the CHECK IT campaign as it relates to course projects.
Funds cover per diem ($1,750) and transportation ($672) for 25 students to advocate in Sacramento, CA. If fewer than 25 students
participate, funds will be reduced proportionately.
Funds to be used toward the printing costs of the course publication (~$600/issue x 10 issues).
INSTRUCTIONALLY RELATED ACTIVITIES (IRA)
2017-18 Fiscal Year Approved Budget
Requests for unallocated funds will be reviewed at the end of each semester unless an extenuating circumstance can be demonstrated by
the program that it should be considered sooner as determined by the IRA Committee Chair. Assistance will be considered in the areas of
allowable IRA expenditures including transportation, per diem, supplies and services, registration, and publicity. Funds will be allocated
on a matching basis on an amount not to exceed 50% of the total expenditures as demonstrated by receipts. This maximum amount
requirement may be amended by a two-thirds (2/3) majority of the IRA Committee.
Funds for supplies and services for exhibitions, including shipping, transportation, exhibit rental fees, materials, production and graphic
services.
3
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
10 Forensics TO140 D40004 P0061 $36,420 $38,100 $30,000
606002 - TRAVEL OUT OF STATE $25,150
660009 - TRAINING AND PROF DEVELOPMENT $4,850
BUDGET LANGUAGE: TOTAL $30,000
11 Forestry Conclave TO140 D40004 P0069 $26,045 $32,502 $29,262
$8,045 $8,631 $7,551
606001 - TRAVEL IN STATE $6,451
660009 - TRAINING AND PROF DEVELOPMENT $1,100
BUDGET LANGUAGE: SUBTOTAL $7,551
$18,000 $23,871 $21,711
606002 - TRAVEL OUT OF STATE $19,211
660009 - TRAINING AND PROF DEVELOPMENT $2,500
BUDGET LANGUAGE: SUBTOTAL $21,711
TOTAL $29,262
12 KRFH-AM RADIO TO140 D40004 P0062 $9,600 $10,000 $10,000
660003 - SUPPLIES AND SERVICES $8,000
606001 - TRAVEL IN STATE $1,000
660017 - ADVERTISING & PROMO PUBLICTION $1,000
BUDGET LANGUAGE: TOTAL $10,000
13Leadership in Volunteer
Organizations TO140 D40004 P0070 $6,079 $6,449 $6,449
660003 - SUPPLIES AND SERVICES $1,000
606001 - TRAVEL IN STATE $5,449
BUDGET LANGUAGE: TOTAL $6,449
14 Lumberjack Newspaper TO140 D40004 P0065 $37,500 $32,000 $32,000
660802 - PUBLICATIONS $32,000
BUDGET LANGUAGE: TOTAL $32,000
CA Competition
West Region Competition
Funds to be used toward per diem ($13,392) and transportation ($5,819) for 24 students to participate in the Western Regional Forestry
Conclave. Training and Professional Development funds ($2,500) cover conclave registration fees. If fewer students participate, funds
will be reduced proportionately.
Funds for course productions including music system maintenance, supplies, and copyright fees/dues ($8,000); travel to the CBI Radio
Conference ($1,000); and program guides and promotional items ($1,000).
Funds to be used toward per diem ($4,249) and transportation ($1,200) for YES Student Program Directors to participate in the YES fall
and spring retreats. Funds for supplies and services include printing, postage, Live Scanning and DMV reports for volunteers.
Funds to be used toward the printing costs of the course publication (~ 28 issues x 16-20 pages each).
Funds to be used toward per diem ($11,730) and transportation ($13,420) for 8 or 16 students (depending on the event) to participate in
debate tournaments in OR and WA. Training and Professional Development funds cover tournament registration fees. If fewer students
participate each tournament, funds will be reduced proportionately.
Funds to be used toward per diem ($3,722) and transportation ($2,729) for 36 students to participate in the Fall Forestry Conclave in CA.
Training and Professional Development funds ($1,100) cover conclave registration fees. If fewer students participate, funds will be
reduced proportionately.
4
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
15 Marching Lumberjacks TO140 D40004 P5116 $28,075 $29,335 $21,964
606001 - TRAVEL IN STATE $21,964
BUDGET LANGUAGE: TOTAL $21,964
16 Master Diver Training TO140 D40004 P0109 $0 $12,590 $3,807
606001 - TRAVEL IN STATE $3,807
BUDGET LANGUAGE: TOTAL $3,807
17 MID-PACIFIC CONFERENCE TO140 D40004 P0110 $0 $4,600 $4,600
606001 - TRAVEL IN STATE $3,150
660009 - TRAINING AND PROF DEVELOPMENT $1,450
BUDGET LANGUAGE: TOTAL $4,600
18 Model United Nations TO140 D40004 P0283 $20,750 $23,600 $23,600
660009 - TRAINING AND PROF DEVELOPMENT $3,520
606001 - TRAVEL IN STATE (Far West) $10,670
606002 - TRAVEL OUT OF STATE (New York) $8,960
660003 - SUPPLIES AND SERVICES $450
BUDGET LANGUAGE: TOTAL $23,600
19Modern Hispanic Theatre
Workshop TO140 D40004 P0381 $0 $2,300 $2,300
660003 - SUPPLIES AND SERVICES $1,900
660017 - ADVERTISING & PROMO PUBLICTION $400
BUDGET LANGUAGE: TOTAL $2,300
Funds to be used for supplies, services and publicity associated with the course's culminating performance.
20 Moot Court TO140 D40004 P0111 $0 $8,068 $4,000
660009 - TRAINING AND PROF DEVELOPMENT $1,500
606001 - TRAVEL IN STATE $2,500
BUDGET LANGUAGE: TOTAL $4,000
Funds to be used toward per diem ($3,150) and registration fees ($1,450) for 15 students to participate in the competition in Chico, CA. If
fewer students participate, funds will be reduced proportionately.
Funds to be used toward two Model United Nations events: Far West (held in San Francisco) per diem ($8,960) and
transportation/parking ($1,710) for 32 students to participate; New York per diem ($3,360) and transportation ($5,600) for 8 students to
participate. Training and Professional Development cover registration for both events (FW = $2,240 and NY = $1,280). If fewer students
participate, funds will be reduced proportionately.
Funds to be used toward per diem ($1,532) and transportation ($968) for 20 students to participate in the regional tournament. Training
and Professional Development funds go toward registration fees ($1,500).
Funds to be used toward per diem ($13,195) and transportation ($8,769) for student Marching Lumberjacks to participate in parades and
festivals across CA, as well as one away football and one away basketball game. Program no longer a class; received an exception April,
2017.
Funds to be used toward per diem and transportation for students to travel to USC for training.
5
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
21 Music: TO140 D40004 see below $95,000 $103,264 $80,107
Brass Ensemble/Music TO140 D40004 P5204 660003 - SUPPLIES AND SERVICES $1,575 $1,418
Calypso Band TO140 D40004 P5261 660003 - SUPPLIES AND SERVICES $9,000 $8,100
University Singers/Music TO140 D40004 P5207 660003 - SUPPLIES AND SERVICES $2,500 $2,250
Woodwind Ensemble/Music TO140 D40004 P5245 $5,920 $5,328
660003 - SUPPLIES AND SERVICES $2,100
606001 - TRAVEL IN STATE $2,978
660009 - TRAINING AND PROF DEVELOPMENT $250
Humboldt Chorale TO140 D40004 P5263 660003 - SUPPLIES AND SERVICES $2,500 $1,000
Instrument Repair TO140 D40004 P5275 660003 - SUPPLIES AND SERVICES $8,600 $6,836
Jazz Combo/Music TO140 D40004 P5230 $2,565 $2,309
660003 - SUPPLIES AND SERVICES $74
606001 - TRAVEL IN STATE $1,910
660009 - TRAINING AND PROF DEVELOPMENT $325
Jazz Orchestra TO140 D40004 P5215 660003 - SUPPLIES AND SERVICES $3,250 $2,925
Mad River Transit/Music TO140 D40004 P5255 660003 - SUPPLIES AND SERVICES $2,500 $2,250
Madrigals/Music TO140 D40004 P5243 660003 - SUPPLIES AND SERVICES $2,500 $2,250
Music Publicity TO140 D40004 P5209 660017 - ADVERTISING & PROMO PUBLICTION $5,690 $3,651
Opera Workshop/Music TO140 D40004 P5222 660003 - SUPPLIES AND SERVICES $18,645 $14,500
Percussion Ensemble/Music TO140 D40004 P5225 660003 - SUPPLIES AND SERVICES $15,000 $7,000
Piano Performance TO140 D40004 P5266 660003 - SUPPLIES AND SERVICES $300 $270
String/Music TO140 D40004 P5251 660003 - SUPPLIES AND SERVICES $405 $365
Wind Ensemble
(formerly Symphonic Band) TO140 D40004 P5233 $19,364 $17,000
660009 - TRAINING AND PROF DEVELOPMENT $320
660003 - SUPPLIES AND SERVICES $3,024
606001 - TRAVEL IN STATE $13,656
Symphony/Music TO140 D40004 P5252 660003 - SUPPLIES AND SERVICES $2,950 $2,655
TOTAL $80,107
BUDGET LANGUAGE:
22Oh Snap! Campus Food
Security TO140 D40067 P0398 $21,620 $21,620 $20,000
660830 - SUPPLIES-FOOD $20,000
BUDGET LANGUAGE: TOTAL $20,000
23 Osprey TO140 D40004 P0056 $10,500 $10,500 $10,500
660802 - PUBLICATIONS $10,500
BUDGET LANGUAGE: TOTAL $10,500
The Music Department is granted flexibility to redistribute funds between these programs within IRA guidelines up to $80,107.
These funds are to be used to purchase food for the HSU Food Security Program Food Cupboard. Contact the AS
Executive Director if the program’s ProCard spending limits need to be adjusted to accommodate efficient food
purchasing.
Funds to be used toward the printing costs of the course publication (~3000 copies x 2 issues).
6
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
24Outdoor Leadership
Assistantship TO140 D40004 P0403 $9,624 $16,905 $9,624
606001 - TRAVEL IN STATE $8,199
660003 - SUPPLIES AND SERVICES $925
660009 - TRAINING AND PROF DEVELOPMENT $500
BUDGET LANGUAGE: TOTAL $9,624
25 Race to Zero TO140 D40004 P0112 $0 $3,400 $3,400
606002 - TRAVEL OUT OF STATE $3,400
BUDGET LANGUAGE: TOTAL $3,400
26 Range Plant ID Team TO140 D40004 P0067 $6,420 $7,520 $6,420
606002 - TRAVEL OUT OF STATE $5,060
660009 - TRAINING AND PROF DEVELOPMENT $1,360
BUDGET LANGUAGE: TOTAL $6,420
27 SAF Quiz Bowl Team TO140 D40004 P0073 $6,500 $6,360 $6,360
660009 - TRAINING AND PROF DEVELOPMENT $1,260
606002 - TRAVEL OUT OF STATE $5,100
BUDGET LANGUAGE: TOTAL $6,360
28 Scientific Diving/Reef Check TO140 D40004 P0400 $9,360 $14,488 $14,488
606001 - TRAVEL IN STATE $12,590
660009 - TRAINING AND PROF DEVELOPMENT $1,898
BUDGET LANGUAGE: TOTAL $14,488
29 Social Work Advocacy Days TO140 D40004 P0395 $8,945 $9,725 $6,500
660009 - TRAINING AND PROF DEVELOPMENT $2,375
606001 - TRAVEL IN STATE $4,125
BUDGET LANGUAGE: TOTAL $6,500
30 Sports Clubs TO140 D40064 P5132 $48,000 $53,500 $48,000
606001 - TRAVEL IN STATE $32,500
660009 - TRAINING AND PROF DEVELOPMENT $14,000
660003 - SUPPLIES AND SERVICES $1,500
BUDGET LANGUAGE: TOTAL $48,000
Funds to be used toward per diem ($2,660) and transportation ($2,400) for eight students to participate on the Range Plant ID Team and
URM Exam competitions in Reno, NV. Training and Professional Development funds go toward registration fees. If fewer students
participate, funds will be reduced proportionately.
Funds to be used toward per diem ($2,100) and transportation ($3,000) for six students to participate in Albuquerque, NM. Training and
Professional Development funds go toward registration fees. If fewer students participate, funds will be reduced proportionately.
Funds to be used toward per diem ($10,640) and transportation ($1,950) for 38 students to travel to USC. Training and Professional
Development funds cover the 8% administrative fee ($1,138) and the USC facility fee ($5/student/day). If fewer students participate,
funds will be reduced proportionately.
Funds to be used toward per diem ($2,025) and transportation ($2,100) for 25 students to travel to Sacramento, CA. Training and
Professional Development funds cover the NASW registration fees. If fewer students participate, funds will be reduced proportionately.
Funds to be used toward outdoor expedition training as associated with the course. Travel funds include per diem and
transportation; supplies and services include maps, SPOT and satellite phone subscription. Training and Professional
Development include permits and course registration fees for Howland Hill training.
Travel funds to go toward 15 sport clubs traveling over two semesters. Training and Professional Development funds
cover league and tournament dues/fees. Program no longer a class; received an exception October 2012.
Funds to be used for per diem ($1,400) and transportation ($2,000) for four students to travel to Golden, CO, to
participate in a national low-energy building design competition. If fewer students participate, funds will be reduced
proportionately.
7
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
31 Television News Workshop TO140 D40004 P0064 $2,500 $2,500 $2,500
660003 - SUPPLIES AND SERVICES $2,500
BUDGET LANGUAGE: TOTAL $2,500
32 Theatre, Film and Dance $96,120 $104,340 $82,790
Student Productions TO140 D40004 P5228 $72,000 $73,000 $59,170
660003 - SUPPLIES AND SERVICES $56,000
660017 - ADVERTISING & PROMO PUBLICTION $2,170
606001 - TRAVEL IN STATE $1,000
SUBTOTAL $59,170
ACDF TO140 D40004 P5271 $7,220 $7,940 $7,220
606002 - TRAVEL OUT OF STATE $7,220
SUBTOTAL $7,220
KCACTF TO140 D40004 P5249 $14,400 $21,400 $14,400
606002 - TRAVEL OUT OF STATE $14,400
SUBTOTAL $14,400
(HIFF) TO140 D40004 P5112 $2,500 $2,000 $2,000
660017 - ADVERTISING & PROMO PUBLICTION $2,000
SUBTOTAL $2,000
BUDGET LANGUAGE:
TOTAL $82,790
33 Toyon TO140 D40004 P0074 $3,600 $3,600 $3,600
660802 - PUBLICATIONS $3,600
BUDGET LANGUAGE: TOTAL $3,600
34 Wildlife Conclave TO140 D40004 P0068 $27,322 $27,530 $25,000
National & Regional 606002 - TRAVEL OUT OF STATE $19,750
660009 - TRAINING AND PROF DEVELOPMENT $5,250
BUDGET LANGUAGE: TOTAL $25,000
Funds to be used toward travel for 15 students to participate in the Annual Wildlife Quizbowl (8 nights) in Albuquerque, NM, and the
Western Wildlife Students' Conclave (7 nights - location TBD). AWQ per diem ($8,400) and transportation ($2,000); WWSC per diem
($7,350) and transportation ($2,000). Training and Professional Development funds cover the registration fees (AWQ = $4,500; WWSC =
$750). If fewer students participate, funds will be reduced proportionately.
Supplies and services for course productions.
Funds to be used toward the printing costs of the course publication.
Program granted flexibility to redistribute funds for programmatic needs within IRA guidelines up to $82,790.
8
Program Name Fund Dept Program Account # -- Line Item Name2016-17
Budget
2017-18
Request
2017-18
Approved
Budget
35 Special Projects $20,250 $10,000 $7,500
Textbooks on reserve TO140 D40004 P0401 $7,500 $10,000 $7,500
608001 - LIBRARY-BOOKS $7,500
BUDGET LANGUAGE: TOTAL $7,500
36 IRA - ADM EXP - AS TO140 D40004 P0077 $42,319 $30,180 $30,180
613001 - CONTRACTUAL SERVICES $30,180
BUDGET LANGUAGE: TOTAL $30,180
2016-2017
Budget
2017-2018
Requests
2017-2018
Budget
TOTALS $663,000 $749,383 $621,617
Fee Revenue $538,000 $503,000 $503,000
Reserve Allocation $125,000 $118,617
Over/Short $0 ($246,383) $0
Fall 2017 Spring 2018 2017-18 Total
Headcount 8199 7680 7940
Fee Revenue Budget $259,744 $243,302 $503,000
Allocation from IRA Reserves $118,617
Total $621,617
IRA Fee Per Student $32 $32 $64
Actual Fee Revenue with 1% Discount Factor $31.68 $31.68 $63.36
On 6/26/2017Reserves
Committed for 17-18
Projected Reserves 6-30-18
$336,988 $118,617 $218,371
IRA Fee Revenue Projections Provided by the HSU Budget Office:
TO140 IRA Committee Fund Balance
2017-18 Enrollment Forecast - IRA Fee
Funds to be used to acquire physical textbooks for student use via Library Reserve. The 2014-2015 IRA Committee
approved a one-time IRA Reserve allocation of $7,500 for the purchase of textbooks on reserve at the library at their
March 27, 2015, meeting. The 2015-2016 IRA Committee continued funding this request (at $7,500) based on a positive
impact report from the Library Dean. The 2016-2017 IRA Committee is extending the funding another year.
Business service cost for IRA administrative duties.
9
INSTRUCTIONALLY RELATED ACTIVITIES FUNDING GUIDELINES
The I.R.A. fee was established to provide support for essential educational experiences and
activities that aid and supplement the fundamental educational mission of the institution.
Activities eligible for I.R.A. funding are limited to those which:
1. Are discipline / departmentally-based and sponsored.
2. Are integrally related to its formal instructional offerings.
3. Are intensive, structured activities.
4. Reflect active rather than passive student involvement.
5. Are considered to be essential to a quality educational program and an important
instructional experience.
6. Demonstrate skills derived from intensive coursework involvement.
The guidelines presented will therefore exclude funding of the following:
Instructional activities such as field trips, student research projects, course offerings
solely tailored to meet I.R.A. requirements, etc.
GENERAL REQUIREMENTS
1. Students must be regularly matriculated, currently enrolled in any H.S.U. course to
receive I.R.A. funds. Non-Students will not be funded.
2. Activities (competition and production) to be considered for I.R.A. funding should be
the result of a class or classes that are structured with the specific objectives of
creating the activity. Exceptions to the course requirement may be made at the
discretion of the I.R.A. Committee and approved by the H.S.U. President.
3. National or regional competitions that are contingent on qualifying are not funded in
the initial budget process. Funding requests for these additional activities may be
submitted to the Associated Students Business Office upon qualifying. The I.R.A.
Committee will review these requests at the end of each semester.
4. Activity must occur during the fiscal year for which the funds were allocated.
Activities that occur outside of the fiscal year will not be funded.
5. No salaries or wages will be funded.
6. Only actual participation in an activity will be funded
7. No equipment will be purchased with I.R.A. funds. Definition of equipment: Items
over $500 or which last over 2 years.
8. Per Diem: I.R.A. per diem will fund up to $70 for each night away. There is no split
identified for per diem. This is the full amount for food and lodging. Faculty will not be
funded for per diem trips.
9. Travel: I.R.A. does not have its own travel policy. All I.R.A. trips must follow the
H.S.U. Field Trip Policy. Your H.S.U. Department Coordinator is responsible for
generating the trip requests. Once generated, field trip waiver forms will be created in
10
your students’ Student Center. They must “sign” the waiver prior to departing on the
trip(s).
It is expected that I.R.A. programs will request funds for the most reasonable and
economical form of transportation. If the I.R.A. program uses a more expensive form of
transportation, it will be reimbursed at the amount required for a less expensive mode of
travel.
Vehicles: I.R.A. will fund the rental vehicles and reimbursement for actual gas purchases
supported by receipts. You are expected to refuel gas tanks prior to returning rental vehicles
to Plant Operations. The vendor usually charges more for fuel. Personal vehicles will only
be reimbursed for actual gas expenses supported by receipts.
Bus Driver Program Information: The use of any University bus or 15-passenger van
includes a driver provided by Plant Operations. This amount will be included in the
chargeback/invoice from Plant Operations and is an allowable I.R.A. expense. Contact
Plant Operations for driver hourly rate and mileage rate information.
Occasionally I.R.A. programs may need to hire or charter vehicles from private companies.
In these situations, the I.R.A. program has the flexibility to hire vehicles where cost may
exceed that of state transportation.
EVALUATION CRITERIA
1. Educational benefits of the program
2. Identification of student learning outcomes for participants
3. Benefits to student community
4. Number of students benefiting indirectly
5. Number of students participating
6. Overall cultural value to the University
7. Overall educational value to the University
8. Importance to the University as a whole
9. Ratio of past and current student participants to the program cost
10. Costs in comparison to comparable programs at H.S.U.
11. Willingness to attempt to generate income to help support the activity
12. Appropriateness of I.R.A. Fee support as opposed to General Fund support
13. Maximization of program revenue
14. Other sources of funding received by the program area
15. Innovation and new ideas
16. Continuity
17. Cost/benefit ratio
11
DEFINITIONS
TRANSPORTATION:
1. Car rental, bus / driver rental, charter bus, train, gas
2. Airline tickets
3. Bus drivers (for 15-passenger van and H.S.U. bus)
4. Parking, tolls
PER DIEM:
1. $70 per student per night out for food and lodging - There is no split identified for per
diem.
Maximum amount per student per trip is $1,100.
SUPPLIES AND SERVICES:
1. Supplies that support the I.R.A. activity and whose useful life is limited primarily to
the activity itself (i.e. sheet music, film, production, programs, costumes, props).
2. Printing of brochures, programs, publications, posters, announcements, newspaper.
3. Applicable individual fees required in order to participate in an I.R.A. event/program
(i.e. individual insurance premiums, individual fees).
4. No equipment will be purchased with I.R.A. funds. Definition of equipment: Items
over $500 or which last over 2 years.
REGISTRATION:
1. Conference, Conclave, Competition, Team, School fees.
PUBLICITY:
1. Photocopying, costs for designing and printing brochures, posters, flyers, forms, and
other materials related to the specific promotion of the class activity.
TRAVEL
1. I.R.A. Programs must follow H.S.U. Field Trip Policy.
2. The “I.R.A. Travel/Expense Report”https://associatedstudents.humboldt.edu/sites/default/files/ira_travel.personal_expense_report.pdf)
3. “Student Travel Verification Form”
(https://associatedstudents.humboldt.edu/sites/default/files/ira_student_travel_verification_form.pdf)
must include dates of travel, destination, mode of travel.
12
PROCEDURES FOR INSTRUCTIONALLY RELATED ACTIVITIES BUDGETED AREAS
The Associated Students of H.S.U. is the campus agency designated with the responsibility
for handling financial and accounting transactions for Instructionally Related Activities fee
based programs. That responsibility requires following accounting standards and
acceptable business practices that will hold up through an audit of the organization's
records. Providing proper documentation for all transactions made through the Associated
Students is a standard that cannot be compromised.
All groups that receive funds from the Instructionally Related Activities fee are responsible for maintaining a record keeping system. It is your responsibility to verify your records with Oracle Business Intelligence (OBI). If there is a discrepancy, contact the A.S. Business Office at x3771 as soon as possible.
In order to submit Payment Requests, Purchase Orders, etc., the faculty/staff advisor MUST
have a current "Signature Authority Form" (see page 27) on file. Account balance and
transactions can be reviewed in OBI. If a Budget Administrator is added or deleted, the
"Signature Authority Form" must be updated. "Signature Authority Forms" are available
here: https://www.humboldt.edu/forms/node/537.
EXPENDITURES
GENERAL GUIDELINES
In compliance with the Chancellor's Office and generally accepted accounting practices,
documentation of transactions is required to support all "Payment Requests" (See page 24).
The following guidelines are established to clarify this requirement as it applies to I.R.A.
It is important that you read and understand the budget language for your I.R.A.
program. All requests for expenditures must adhere to your program's approved I.R.A.
Budget Language. Expenditure of I.R.A. funds requires that there are sufficient funds in
your account, and that the payment request is properly completed. Checks will not be
available as scheduled if the Payment Requests are not properly completed. The A.S.
Business Office will attempt to notify you of any errors. Checks will be available any time
after Tuesday or Thursday after 3pm. The process may take a few days to complete.
If you have any questions regarding expenditures, do not hesitate to call the A.S. Business
Office at x3771.
13
ACCEPTABLE DOCUMENTATION
1. Vendor invoices which detail the merchandise purchased or services rendered
2. Signed and dated contracts on business letterhead specifically stating services
rendered
3. Detailed receipts which describe purchase or services rendered and reflect amount
paid
4. Gasoline receipts which show # of gallons purchased and unit cost - Prepaid
gasoline receipts will not be accepted because detail is not shown on items
purchased.
5. On-line purchases must have a shipping confirmation as part of documentation.
6. For conference or event registration fees, a memo from the sponsoring organization
can be accepted, in lieu of an itemized receipt, if it contains all of the following:
a. on letterhead of sponsoring organization
b. amount of fees received
c. name and date of event for which the fees were paid
d. name of person (if applicable) paying the fees
e. signature, printed name and phone number of person receiving the fees
UNACCEPTABLE DOCUMENTATION
1. Vendor's monthly statement - it only shows a summary of all the invoice numbers. It
is not acceptable because (1) it does not provide information on items purchased or
services rendered; (2) it is difficult to determine if some or all of the invoices have
been previously paid.
2. Canceled checks, copies of canceled checks, personal checks
3. Credit card slips - not acceptable because detail is not shown on items purchased
4. Personal note/memo stating services rendered or items purchased
5. Order forms
6. Purchase Orders
7. Any documents that do not clearly reflect amount paid, item purchased or describe
services rendered
8. Copies of receipts or copies of invoices - to ensure that original receipt or invoice has
not been previously paid
9. Packing Slips
10. Prepaid gasoline receipts – not acceptable because detail is not shown on items
purchased
14
SALES OR ‘USE’ TAX
Per California state law, purchases made from out-of-state retailers are subject to ‘use’ tax
and must be reported. The use tax rate for Arcata is 8.5% (and varies by county) of the
purchase price including handling charges. This differs from California sales tax which is
7.25%. Anything purchased from a State that does not have sales tax must include this
8.5% use tax. While the H.S.U. Accounts Payable office will calculate this tax, deduct it from
your I.R.A. account, and remit it to the state, it is important that you deduct this tax in your
program ledgers.
PAYMENT REQUEST
An example of a "Payment Request" is included in the examples section. Forms are
available on the H.S.U. website: https://www.humboldt.edu/forms/node/594
PAYMENT REQUEST REQUIREMENTS
1. All Payment Requests must be submitted with proper receipts or original invoices to
the A.S. Business Office in order to be processed (See “Reimbursement
Requirements” below if the payment request is to reimburse an individual).
2. If the vendor/payee requires that the invoice be sent with the remittance, be sure to
include an additional copy of the invoice so we can retain the original for our records.
3. When paying a vendor, a separate payment request is needed for each invoice.
4. All Payment requests must include an address for the payee. Payment requests
without an address will not be processed. Please list an off campus address.
5. Payee Data Record STD 204 - The Internal Revenue Service requires that payment
for certain services (i.e. rent, speeches, graphic services, donations, etc.) to
individuals or an unincorporated business be reported on an annual basis. The
individuals/businesses which receive payment for services rendered are required to
fill out a Payee Data Record STD 204 (See page 22) before their checks can be
released. Payee Data Record STD 204 are available online athttp://www.humboldt.edu/forms/node/134
6. See the TRAVEL section for additional details on travel expenditures.
7. Payment requests must be signed by the Budget Administrator as the “Approved
Project Signer” before payment will be issued. The supervisor of the program director
must sign the “One Up” signature space on the form. (For example, the department
chair, dean or director.)
8. It is recommended you retain a copy of the payment request for your records.
9. Checks may be picked up at the H.S.U. Cashier’s Office (SBS Building, 2nd floor) or
mailed. Please indicate on Payment request if the check is to be mailed or picked up.
Checks not picked up after two weeks will be mailed to the address given on the
Payment request.
15
REIMBURSEMENT REQUIREMENTS
1. Requests for payment or a reimbursement to a Program Director and/or Budget
Administrator require a “One-Up Signature” for expenditure of any funds. The
supervisor of the program director must sign the “One Up” signature space on the
form. (For example, the department chair, dean or director.)
2. Requests for reimbursement to an individual must be processed with original
supporting documentation attached.
3. The documentation must clearly describe the nature of the expenditure. In other
words, non-itemized receipts with just a total of the expense are not allowable
documentation.
4. Original supporting documentation must be in the form of an invoice or receipt.
Photocopied or faxed invoices/receipts will not be processed for payment.
IMPORTANT NOTE! Please note that there have been changes to the format in which
receipts need to be turned in:
1. One receipt amount per line on a payment request.
2. For scanning purposes, receipts must be submitted in a ready-to-scan format.
Receipts must be taped in a single layer to a separate sheet(s) of paper. Do not
staple receipts or sheet to payment request. Please do not overlap the receipts.
3. Payment requests to vendors - Only process one invoice per payment request.
Example: Three invoices from ACE Hardware require three separate Payment
requests.
4. Personal items and/or other non-reimbursable items may not be listed on the
receipts.
ACCEPTABLE DOCUMENTATION
1. Vendor invoices which detail the merchandise purchased or services rendered2. Signed and dated contracts on business letterhead specifically stating services
rendered3. Detailed receipts which describe purchase or services rendered and reflect amount
paid4. Gasoline receipts which show # of gallons purchased and unit cost - Prepaid
gasoline receipts will not be accepted because detail is not shown on itemspurchased.
5. On-line purchases must have a shipping confirmation as part of documentation6. For conference or event registration fees, a memo from the sponsoring organization
can be accepted, in lieu of an itemized receipt, if it contains all of the following:a. on letterhead of sponsoring organizationb. amount of fees receivedc. name and date of event for which the fees were paidd. name of person (if applicable) paying the feese. signature, printed name and phone number of person receiving the fees
16
UNACCEPTABLE DOCUMENTATION
1. Vendor's monthly statement - it only shows a summary of all the invoice numbers. Itis not acceptable because (1) it does not provide information on items purchased orservices rendered; (2) it is difficult to determine if some or all of the invoices havebeen previously paid.
2. Canceled checks, copies of canceled checks, personal checks3. Credit card slips - not acceptable because detail is not shown on items purchased4. Personal note/memo stating services rendered or items purchased5. Order forms or purchase orders6. Any documents that do not clearly reflect amount paid, item purchased or describe7. services rendered8. Copies of receipts or copies of invoices - to ensure that original receipt or invoice has
not been previously paid9. Packing Slips10. Prepaid gasoline receipts – not acceptable because detail is not shown on items
purchased
I.R.A. FUND DEPOSIT
A.S. Business Office now uses a different deposit form. Deposits are to be delivered to the
H.S.U. Cashier’s Office (SBS, 2nd Floor).
DEPOSIT FORMS
Return of ASB Funds – This form is used when a program will need to return unused funds
from an advance. (See page 26) https://associatedstudents.humboldt.edu/sites/default/files/humboldt_state_cashier_-
_return_of_asb_funds.pdf
DEPOSIT INSTRUCTIONS
1. The forms must be completed before submitting.
2. The cashier’s office only accepts cash or checks.
3. If you do not know the department and program number, contact your Budget
Administrator.
17
PURCHASE ORDER REQUESTS
"Purchase Orders” (see page 25) are used whenever it is necessary to procure items
without prepayment. Purchase order Forms can be found in the following link:
https://associatedstudents.humboldt.edu/sites/default/files/purchase_order.pdf.
1. Purchase Orders are issued to vendors as assurance that payment will be remitted
for items being ordered/purchased. Purchase orders do not reflect as an expenditure
on your account until a "Payment Request” (See Page 24) is submitted for payment.
When you receive the invoice, complete a payment request, attach the invoice, and
send both to the A.S. Business Office. (Remember - Purchase orders are not
acceptable documentation as back up for a Payment request).
2. Purchase orders can be emailed to you. Please use this form for your purchase
orders (thus eliminating the need for a Stateside “Requisition for a Purchase order”).
3. Purchase orders must be completed by the I.R.A. program and turned in to the A.S.
Business Office signed by the appropriate party. The A.S. Business Office will then
process the Purchase Order and issue it to the vendor. You may also want to have a
blanket Purchase Order (e.g., a Purchase Order issued to the H.S.U. Bookstore not
to exceed $50). In this case, you must list the people who will be authorized to
charge items.
4. All Purchase orders must be signed by the Budget Administrator/Advisor and adhere
to your program's I.R.A. Budget Language or it will not be processed.
5. Please allow 24 hours for the A.S. Business Office to process a Purchase Order from
the time it is received in the A.S. Office. Exceptions may be made to “rush” a
Purchase Order due to unforeseen circumstances; but requests due to emergency
situations should not occur on a regular basis.
6. There must be sufficient funds in your account in order for the Purchase Order to be
processed.
TRAVEL
All I.R.A. trips must comply with all requirements as set forth by the H.S.U. Field Trip Policy.
I.R.A. does not have its own travel policy; University policy only applies. These
requirements must be fulfilled prior to any travel advances or reimbursements being issued.
Your H.S.U. Department Coordinator can assist you with generating the trip request(s).
The most current forms needed for travel are available on the H.S.U. Forms Page.
If you have any questions regarding this information, please contact Procurement and Risk
Management at (707) 826-3312 or the A.S. Business office at (707) 826-3771.
18
I.R.A. TRAVEL REIMBURSEMENT REQUIREMENTS
I.R.A. programs that travel must complete and submit an "I.R.A. Travel/Personal Expense
Report" which can be found here: https://associatedstudents.humboldt.edu/sites/default/files/ira_travel.personal_expense_report.pdf
(See page 20).
To receive per diem, make sure a "I.R.A. Student Travel Verification Form” (See page 20) is submitted to the A.S. Business Office for each trip. The “Student Travel Verification Form” is found here: https://associatedstudents.humboldt.edu/sites/default/files/ira_student_travel_verification_form.pdf
If you receive a travel advance, these forms must be submitted to the A.S. Business Office within 10 working days upon returning from the trip.
To ensure you receive your travel advance in time for your trip, please submit the required paperwork to the A.S. Business Office two weeks prior to the date of travel.
Per diem is an allotment for meals and lodging for each student who travels. I.R.A. per
diem will fund up to $70 for each night away.
There is no split identified for per diem.
This is the full amount allowable for food and lodging.
No receipts are required.
Faculty and coaches will not be funded for per diem on trips.
To determine the total that you may request as an advance, or that will be reimbursed
through a Payment Request, multiply $70/Night X Number of Students X Number of Nights.
Example: Number of Student in Travel Party – 12 (twelve) Leave H.S.U. – 6am WednesdayReturn H.S.U. – 9pm Saturday
(Three night area spent on this trip – Wednesday, Thursday, and Friday)
Total Per Diem Allowed: 12 students x 3 nights x $70 = 2,520
Requests for per diem greater than this calculation will not be accepted.
Requests for travel reimbursement must be as approved by the Instructionally Related
Activities Committee budget language.
Important note regarding air travel: Original airline boarding passes and a detailed itinerary
must be submitted with a Payment Request.
Documentation that the H.S.U. Release of Liability was completed must be submitted with a
Payment Request.
19
INSTRUCTIONALLY RELATED ACTIVITIES STUDENT TRAVEL VERIFICATION FORM
DATE: NAME OF PROGRAM:
ACCOUNT NUMBER:
We the undersigned acknowledge we have received or are eligible to receive $ Per Diem for food and/or lodging (or the equivalent of up to $70.00 per night per diem) forthe Instructionally Related Activities event described below:
Event:
Destination:
Departure Date: Time: Return Date: Time:
PLEASE PRINT LEGIBLE
****The above section must be completed in its entirety for the signature section to be valid****
NAME SIGNATURE STUDENT ID #
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
For further information regarding per diem, please contact the Associated Students Business Office at 826-3771
**ATTACH ADDITIONAL SHEETS IF NECESSARY**
OFFICE USE ONLY ACCOUNT NUMBER: Number of Students
Verified: REVIEWED BY:
SAMPLE
20
INSTRUCTIONALLY RELATED ACTIVITIES
TRAVEL / PERSONAL EXPENSE REPORT
TRAVELER/GROUP LEADER: DATE:
DEPARTURE DATE: TIME: RETURN DATE: TIME:
DESTINATION:
PURPOSE OF TRIP OR EXPENDITURE:
NUMBER IN PARTY: ACCT. TO BE CHARGED:
EXPENSES:
TRANSPORTATION (RECEIPTS REQUIRED)
Flights
Auto Rentals
Gas
Parking/Tolls
Check here if state van or bus was used
PER DIEM (Meals and Lodging – Not to exceed $70.00 per night). A completed IRA Signature Form must be attached.
MISCELLANEOUS (RECEIPTS REQUIRED)
TOTAL SPENT
LESS AMOUNT ADVANCED (if applicable)
AMOUNT RETURNED (Cashier deposit receipt attached) OR
TOTAL DUE CLAIMANT AMOUNT OF REIMBURSEMENT IF IRA ACCOUNT BALANCE IS LESS THAN TOTAL DUE CLAIMANT
PAYEE’S SIGNATURE DATE
ASSOCIATED STUDENTS OFFICE USE ONLY
DATE
DATE
REVIEWED BY
EXECUTIVE DIRECTOR'S APPROVAL
COMMENTS:
Include (-) in front of amount.
21
STATE OF CALIFORNIA-DEPARTMENT OF FINANCE Print Clear PAYEE DATA RECORD
(Required when receiving payment from _the State of California in lieu of IRS W-9) STD. 204 (Rev. 6-2003)
IN;:> 1r(Uv11u1'11;:>: Complete all information on this form. Sign, date, and return to the State agency (department/office) address shown at the
IT] bottom of this page. Prompt return of this fully completed form will prevent delays when processing payments. Information provided in this form will be used by State agencies to prepare Information Returns (1099). See reverse side for more information and Privacy Statement. NOTE: Governmental entities, federal, State, and local (including school districts), are not required to submit this form.
PAYEE'S LEGAL BUSINESS NAME (Type or Print)
0 SOLE PROPRIETOR - ENTER NAME AS SHOWN ON SSN (Last, First, M.I.)
I
E-MAIL ADDRESS
MAILING ADDRESS BUSINESS ADDRESS
CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE
0 ENTER FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN): I I I I I I I I I I NOTE:
D PARTNERSHIP Payment will not
PAYEE CORPORATION: be processed
ENTITY D D MEDICAL (e.g., dentistry, psychother~py, chiropractic, etc.) without an
ESTATE OR TRUST D LEGAL (e.g., attorney services) accompanying TYPE D EXEMPT (nonprofit) taxpayer l.D.
CHECK DALL OTHERS number.
·--·---··········-························································---------· -------------------------------···-····-··-··-·-··-·· --·-·····-·-·----····----------------------------------.------------.----·······································--------------------ONE BOX D INDIVIDUAL OR SOLE PROPRIETOR I I I I I I I I I I . ONLY ENTER SOCIAL SECURITY NUMBER:
(SSN required by authority of California Revenue and Tax Code Section 18646)
0 D California resident - Qualified to do business in California or maintains a permanent place of business in Cafifornia.
D California nonresident (see reverse side) - Payments to nonresidents for services may be subject to State income
PAYEE tax withholding.
D No services performed in California.
RESIDENCY D Copy of Franchise Tax Board waiver of State withholding attacfled.
STATUS Certification: My business is certified by the State of California's Office of Small Business Certification and_ Resources (OSBCR) as:
D Disabled Veteran Owned Business (51 % ownership and 10% service-related disability) Cert#
D Small Business Cert#
@] TERMS: HSU standard terms are Net 30 unless payment discount offered.
Payment Terms: I FOB: D Destination D Ship Point
TERMS Type of credit cards accepted: I Fee charged: D No I I Yes (indicate percent) Ship Method: I Freight Terms: ·D Prepaid and Add D Prepaid and Allowed Contractor's License Number: I
@] I hereby certify under penalty of perjury that the information provided on this document is true and correct.
Should my residency status change, I will promptly notify the State agency below.
AUTHORIZED PAYEE REPRESENTATIVE'S NAME (Type or Print) I TITLE
SIGNATURE I DATE I TELEPHONE
~ Please return completed form to:
0 Department/Office: Humboldt State University
Unit/Section: Accounts Payable
Mailing Address: 1 Harpst Street
City/State/Zip: Arcata, CA 95521
Telephone: (707) 826-3512 Fax: (707) 826-3312
E-mail Address: [email protected]
sample
22
STATE OF CALIFORNIA-DEPARTMENT OF FINANCE
PAYEE DATA RECORD STD. 204 (Rev. 6-2003) (REVERSE)
1
2
3
4
Requirement to c.;omplete Payee Data Record, s 1 u. 204
A completed Payee Data Record, STD. 204, is required for payments to all non-governmental entities and will be kept on file at each State agency. Since each State agency with which you do business must have a separate STD. 204 on file, it is possible for a payee to receive this form from various State agencies.
Payees who do not wish to complete the STD. 204 may elect to not do business with the State. If the payee does not complete the STD. 204 and the required payee data is not otherwise provided, payment may be reduced for federal backup withholding and nonresident State income tax withholding. Amounts reported on Information Returns (1099) are in accordance with the Internal Revenue Code and the California Revenue and Taxation Code.
Enter the payee's legal business name. Sole proprietorships must also include the owner's full name. An individual must list his/her full name. The mailing address should be the address at which the payee chooses to receive correspondence. Do not enter payment address or lock box information here.
Check the box that corresponds to the payee business type. Check only one box. Corporations must check the box that identifies the type of corporation. The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State provide their Taxpayer Identification Number (TIN). The TIN is required by the California Revenue and Taxation Code Section 18646 to facilitate tax compliance enforcement activities and the preparation of Form 1099 and other information returns as required by the Internal Revenue Code Section 6109(a).
The TIN for individuals and sole proprietorships is the Social Security Number (SSN). Only partnerships, estates, trusts, and corporations will enter their Federal Employer Identification Number (FEIN).
Are you a California resident or nonresident?
A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary of State to do business in California.
A partnership is considered a resident partnership if it has a permanent place of business in California. An estate is a resident if the decedent was a California resident at time of death. A trust is a resident if at least one trustee is a California resident.
For individuals and sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a pai:ticular contract of short duration will be considered a nonresident.
Payments to all nonresidents may be subject to withholding. Nonresident payees performing services in California or receiving rent, lease, or royalty payments from property (real or personal) located in California will have 7% of their total payments withheld for State income taxes. However, no withholding is required if total payments to the payee are $1,500 or less for the calendar year.
For information on Nonresident Withholding, contact the Franchise Tax Board at the numbers listed below: Withholding Services and Compliance Section: 1-888-792-4900 E-mail address: [email protected] For hearing impaired with TDD, call: 1-800-822-6268 Website: www.ftb.ca.gov
Certification: If applicable, please include the Certification Number associated with the type of business.
5 Provide the payment terms as well as shipping information.
6 Provide the name, title, signature, and telephone number of the individual completing this form. Provide the date the form was completed.
7 This section must be completed by the State agency requesting the STD. 204.
Privacy Statement
Section 7(b) of the Privacy Act of 197 4 (Public Law 93-579) requires that any federal, State, or local governmental agency, which requests an individual to disclose their social security account number, shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.
It is mandatory to furnish the information requested. Federal law requires that payment for which the requested information is not provided is subject to federal backup withholding and State law imposes noncompliance penalties of up to $20,000.
You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the State agency(ies) with which you transact that business.
All questions should be referred to the requesting State agency listed on the bottom front of this form.
sample
23
PAYMENT REQUEST FORM I PrinHorm
Send Original form to Accounts Payable r--------------------------------------------------------------------------------------------------------------------------------c----------------------------------1 ! 0 Check this box to PICK UP CHECK at the CASHIER'S office at the SBS BUILDING, 2nd floor. !
l _________________________________________________ ~!~~-=~-~~~~-~~-~-~-~~-=~-~-~~-~~-~:~~~-~-~~~-~~~-~-~~~-~~~~:---------~------------------------------j Business Unit Vendor D Must use current mailing address
Employee D Must use campus address
Student D Must use current mailing address
A Payee Data Form (Form 204) must be completed by the vendor if not currently on file
Date:
Payable to: HSU ID:
Address:
Phone#
Department: Contact:
Total Amount: $ 0.00 Project Name:
Line Item Name Amount Account Fund
?
Ext:
Project II II II II II II
Dept. ID# II Program II Class II ~--~ll~_l::==I ===:l~I =====:
Explanation:
I hereby certify upon my knowledge that the budgeted funds are available for this expenditure, and that this expenditure is in keeping with the designated purpose of this account. By checking the HMS PF box, I further certify that, in the case of payroll advances, this pay period was calculated as above. In the case of travel, I certify that duplicate payment through other accounts has not a11d will not occur; I certify funds are from 'non-state sources and within the travel rules allowed by the funder. In the case of grants/contracts, I certify these expenditures took place within .the period of performance.
Department Certification/Approved Project Signer "One Up" Signature (if needed)
Print Name Print Name
FOR ACCOUNTS PAYABLE USE ONLY
Last Updated: April 14, 2017
sample
24
DATE:
NO.
Company
Address
City, State,
Zip
Phone
Fax
Quantity Unit Unit Price Amount
Account
Line-Item
Account No.
Approved By
DIRECTOR OF ACTIVITY
Description
Tax
Shipping
Total
INVALID IF NOT INVOICED WITHIN SIX (6) MONTHS
Copies to: A.S. Business Office, Director of
Activity, HSU Shipping and ReceivingA.S. EXECUTIVE DIRECTOR
This number must appear on all packages, invoices, etc.
NOT VALID WITHOUT AN A.S. ISSUED PO #
THIS PURCHASE ORDER MUST BE PROCESSED THROUGH THE A.S. BUSINESS OFFICE
Subtotal
PURCHASE ORDER
Mail invoices to:
Associated StudentsHumboldt State University
Arcata, California 95521
(707) 826-3771
SHIP TO
25
Humboldt State Cashier's Receipting Instruction
Return of ASB Funds
Receipt to: ________________________________ (Name or vendor on check)
Please receipt: ___________ (total amount) into the following accounts:
______________________________________________________________________ (Description of funds)
Item Code AS Abate: ________________
Reference: ________________
Amount: ________________
Account Fund Dept. Program
Chartfield 250002 AS100
Item Code AS Abate: ________________
Reference: ________________
Amount: ________________
Account Fund Dept. Program
Chartfield 250002 AS100
Prepared by: ________________ Department: ________________ Date: ________________
Approved: __________________
sample
26
D HMCMP
D HMADV
l\. HUMBOLDT UNIVERSITY
SIGNATURE AUTHORITY FORM
.Add/Remove Additio.nal Page ··· .. ·" ..
I . · Print Form
Please provide the requested information for all personnel authorized to expend funds. Forms must be completed and kept on file in the Procurement office. Please call our office at extension 3512 if you have any questions.
please sen_d gr_lgi11g/ signec/. q~c/. c_omplett!d f!qct1m:e1Jt to .. · · ·· · · ·· Business services; 585 345. · ·· · · ·· ·
Department Authorizer Name Title
Signature Date ·Department Authorizer who is issuing signature rights to those listed below.
Fund Code Department ID Department Name ·Inactive Date (if applicable) < .. ,, ... -.'' .....
Print Name Signature
Fund Code Department ID Department Name Inactive Datt! (if applicable) ,,.,, .. ;;.;
'""•" .. ..
Print Name Signature /
Fund Code Department ID Department Name Inactive Date (if applicable} '. ~' '
i'L~ •' < ~::-..
Print Name Signature
Fund Code Department ID Department Name .Inactive Date (if applii:able) ·. I .. . ..
Print Name Signature
sample
27