Check Request Forms (UoW 1570 / 1571) and Instructions

Check the appropriate box on the form:

• Reimbursement (Attachments Required) -
  Original receipts showing proof of payment must be provided. A perjury statement can be used in situations where the receipts are not available.
  
  
  
• Honorarium
  Payments to non-UW employees for specific services such as lecturers and performers. The check request form cannot be used to pay service contracts (see page on Consulting, Personal Services and Payments to Individuals)
  
  
  
• Other - must provide appropriate explanation. May include payments to research subjects, prizes, awards for non-UW students, student performers, royalties, permission fees and copyrights.

Required field for Honorariums and Research Subjects.
Can designate range of dates or final date of service.

Name of Department (and Unit if necessary) requesting check.

UW Employee preparing the documents.

Phone number of the Department Contact.

UW Employee with knowledge of actual transaction.

 

Phone number of the Technical Contact (see above).

 

Current campus mail stop.

 

• U.S. CITIZEN - native born or naturalized
• NON-RESIDENT ALIEN - temporary visitor from another country. Additional documentation is needed. See the Global Operations Support page for more information.
• RESIDENT ALIEN - Permanent Resident (non-U.S. citizen) working and living in the United States. This individual is usually referred to as a "green card holder".

Required for Honorariums, services, consulting fees, lecturers, rent, repairs and maintenance, copyrights, royalties, permission fees, prizes and awards, healthcare providers, and attorneys.

This number will be a Social Security Number (SSN); Employer Identification Number (EIN) if paid to a sole proprietorship or partnership; or Individual Taxpayer Identification Number (ITIN) in the case of non-resident alien individuals.

Note: Fields 1, 2, 3, 4 and 5b are limited to 40 characters, including spaces.

1. VENDOR CLAIMANT NAME - full legal name of recipient as registered (person or company) with the Internal Revenue Service or the Social Security Administration. The first name of an individual should appear first on the line.

• Do not include nicknames, titles or formalities (such as Mr. Mrs. Dr. etc) with the name.
• Do not put any part of the name in parentheses.
• Do not use initials (should be written John D. Doe not J. D. Doe).

2. (Use this field if name in line 1 is over 40 characters long.)

3. PERMANENT ADDRESS - should be home address of the payee or personal PO Box.(No UW addresses.) Note: Do not list payee's work address as their permanent address.

4. Use for second line of address. Also used for City, State, County, Province and Postal Codes for Foreign vendors.

5a. CITY, STATE, ZIP - Use for US vendor addresses only. (Use line 4 for Foreign city information.)(City can be no more than 28 characters long.)

5b. COUNTRY (Foreign) - Use only for foreign vendors

The department is responsible for obtaining the signature of the individual being reimbursed.

Check appropriate box. Partial or full payments requested in advance of the service ending date must be marked either Hold for Pick-up or Sent to Department. If not indicated the check will be processed on the service end date and sent directly to the payee.

• MAIL TO PERMANENT ADDRESS - check will be sent to address in section 13.
• HOLD FOR PICK-UP:
  • CALL - provide first and last name of individual to be called when check is ready.
  • PHONE - provide full phone number of the individual requesting the pick up.
• SENT TO:
  • 3. C/O - Provide name or department to where the check should be sent
  • 4. BOX - University mail-stop

Use only to provide Financial Services with instructions not covered in Check Handling Instructions (i.e. Wire Transfer, foreign currency, UPS, Courier pick-up, overnight express) Please include the budget number or Fed Ex account number to charge the mailing fee to for overnight express.

Describe:

• what was purchased and describe the business purpose of the items
• what service was performed
• when the purchase was made or the when the activity took place
• where the purchase was made or where the activity took place, and an itemization of the expenditure including extension of quantity x price or the amount to be paid for the activity.

Reimbursement of entertainment must include the names of all persons attending affair and the purpose of the meeting.

If a reimbursement of travel related to an honorarium includes meals, the meals must be itemized. Note: Meal receipts are required. Only one line is allowed for quantity, unit and unit price. The extended amount is calculated automatically on the on-line form.

If Non-Resident Alien, please describe whether the work was performed inside or outside the United States.

Total of all items listed in detail description. (Automatically calculated on on-line form.)

Taxes deducted under certain conditions (i.e. tax ID missing, NRA payments when required by law).

Subtotal less any withholding.

Requesting department must provide all accounting information necessary to record the payment properly. If more than one budget or object code is used, the department must provide a breakdown. The form only allows for five lines of accounting detail. If you need additional lines, consider splitting the request into two or more parts or you may fill out two check request forms with the same reference number.

• BUDGET NUMBER - Six digits only (##-####)
• OBJ/SUB/SSUB - Two digits per field (## - ## - ##)
• TASK, OPTN, PROJECT - Optional. Use only as needed.
• USE TAX - Financial Services use. The State of Washington requires us to assess taxes on purchases made from vendors which do not collect sales tax for the State. If a receipt does not show that sales tax was charged, we are required to calculate and pay the tax to the State. This will result in a higher amount appearing on your BAR than was actually paid to the payee.
• AMOUNT - Foreign currency conversion should be provided to Financial Services based on the value of the currency when purchased through our service agent.
• INVOICE/REFERENCE NUMBER - Required. Requesting Department must provide a unique reference number for each check request. This number is necessary as a reference on the BAR and as a tracking device for Financial Services document logging.
• DATE PREPARED - Required.
• Shaded Accounting line - Financial Services use only to record withholding for tax purposes.

While it is required that the authorized official sign this document, is is strongly recommended that a separate individual prepare the document in order to guard against fraud.

Required if signed by a preparer. Date the paperwork was completed

Signature of the person in the department with budget authority.

Date the request was approved by the person with budget authority.

An explanation of why the payments are being made (i.e., Research Subjects)

Date or period of time covered by the payments.

Name of department requesting payment.

 

Name of person Financial Services can contact, if needed.

Phone number of Department Contact.

Campus mailbox for department.

Please mark appropriate box(es). U.S. Citizens and Resident Aliens may be included on the same multiple check request form. Non-Resident Aliens (NRA's) cannot be paid on this form.

• U.S. CITIZEN - Native born or naturalized
• RESIDENT ALIEN - Permanent Resident (non-U.S. citizen) working and living in the United States. This individual is usually referred to as a "green card holder".

While it is required that the authorized official sign this document, it is strongly recommended that a separate individual prepare the document in order to guard against fraud.

Required if signed by a preparer. Date paperwork was completed.

Signature of person who has budget approval.

Date approval was made

Check appropriate box.

• MAIL TO PERMANENT ADDRESS - Mark this box if you wish all checks to be mailed to the payees.
• HOLD FOR PICK-UP:
  • PHONE - Phone number of above person
  • CALL - Name of person to be called when checks are ready
• SEND TO:
  • 3. C/O - Name of person to whom the checks should be sent
  • 4. BOX - Campus mail stop for c/o person

Identifier assigned by the department to appear as reference on the BAR. This number is also used to help the Payman team track the document. Unlike individual form, all payments on this form will have same reference number.

Date form is completed.

Budget to be charged must be same for all payees on form.

Expenditure code to be charged must be same for all payees on form.

Some payees may have been assigned vendor numbers in the vendor control file. If the department is aware of the number it may fill in this information. It is an eight-digit number. If a vendor number is used, the payee must not be included on a form with payees who do not have vendor numbers.

Required for any payment made that is reportable to the Internal Revenue Service (IRS) (i.e., Honorariums, Research Subjects). This number is the person's Social Security Number (SSN).

If an EIN is used, use form UoW 1570. Please key Social Security Number as ###-##-####.

This is filled in by Financial Services during processing.

1. NAME AS RECORDED WITH IRS OR SOCIAL SECURITY - Required.
This must be the legal registered name of the payee.

• Do not include nicknames, titles or formalities (such as Mr. Mrs. Dr. etc) with the name.
• Do not put any part of the name in parentheses.
• Do not use initials (should be written John D. Doe not J.D. Doe).

3. PERMANENT ADDRESS - Required.
Permanent street address of payee, i.e. home address or post office box.
Do not list a work address as the permanent address.

4. PERMANENT ADDRESS (FOREIGN CITY AND ZIP) (or Postal Code) - Optional
Used as additional address line of payee for U.S. addresses and for the city and zip of addresses in foreign countries.

Zip or Postal Codes are required for Canada, United Kingdom and Australia. Payees with a foreign address must be on a separate form from those with U.S. addresses.

5. CITY, STATE AND ZIP CODE (FOREIGN COUNTRY) - Required.
Used for city, state and zip code on U.S. addresses and for the name of the foreign country if payee resides outside the U.S. Payees with a foreign address must be on a separate form from those with U.S. addresses.

An amount must be filled in for each payee.
Do not use ditto (") marks. The system will add cents (.00) for whole dollars when the field is left blank. Please verify that the system shows both dollars and cents before printing form.

This is always N.

Automatically calculated by the system when you exit the U.S. Dollar Amount field

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