Custodian Fund Forms

Check Register Worksheet

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Check Register Worksheet

Download Check Register Worksheet (xlsx)

Instructions

  • When using the check register, complete the top portion with the requested information.
  • The DATE column is the date the check was written.
  • The CHECK # column is for the check number, if applicable.
  • After the check has cleared the bank, place an “X” in the STATUS OF CHECK column. If a stop payment is placed on a check, place an “S” in the STATUS OF CHECK column. If a check is voided, place a “V” in the STATUS OF CHECK column.
  • Record the check recipient or vendor’s name in the PAYEE REFERENCE column. For research participants, we recommend using unique participant numbers or initials to keep names confidential. For vendors, we need their complete name.
  • Reminder: Contingent bank accounts need to submit receipts along with the check register for replenishment.
  • Reminder: Custodian Funds for research participant studies, such as replenishable bank accounts and temporary funds, need to maintain participant logs at site and obtain W-9’s per Policy UW-3005 – Payments to Research Participants.

Bank Account Reconciliation Worksheet

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Bank Account Reconciliation Worksheet

Download Bank Reconciliation Worksheet (Excel – .xlsx)

Instructions

  1. Steps to balance your bank account
    1. Fill out the top portion of the bank reconciliation worksheet.
    2. Enter the month end balance from the bank statement.
    3. Enter any deposits in transit as of the end of the month you are reconciling.
    4. Enter the month end balance from the check register.
    5. Enter all outstanding checks as of the end of the month you are reconciling. Outstanding checks are those that have not cleared.
    6. Enter any outstanding adjustments as of the end of the month you are reconciling.
    7. The Adjusted Bank Statement Balance and the Adjusted Check Register should equal.
  2. Steps to balance to the authorized Custodian Fund amount
    1. Enter the checks written through the month you are reconciling that have not been replenished.
    2. Enter the total amount of checks that have a stop payment. Enter the amount as a negative amount. Note that checks 90 days or older are to have a stop payment placed in US Bank SinglePoint.
    3. Enter the current authorized amount.
    4. Difference should be zero.
    5. Total amount of replenishment that needs to be requested from Cash Management to replenish the bank account. Note that replenishments are to be completed at least every 90 days or sooner.

Download an Illustration of Instructions (Excel – .xlsx)

Custodian Fund Request Form

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This form is used to request custodian funds for Human Subjects Studies, Change Fund and Petty Cash.

A form used to request custodian funds for Human Subjects Studies, Change Fund, and Petty Cash.

Custodian Fund Request Form (PDF)

How to complete the Custodian Fund Request Form

  1. Provide details about the requested fund. Based on your budget form, enter a positive amount for the total of the request. Enter the Account, Fund, Dept. ID, Prog. (Program), Project you want these expenditures to be charged to.
  2. Enter unique 7-digit Custodian Fund ID from original Custodian Fund Request Form. All custodian funds will start with NR, followed by the unique 7-digit Custodian Fund ID.
  3. Put an “X” in the “Type of Custodian Fund Request” section (i.e. Research Participant Study, Petty Cash, Change Fund, or Reloadable Debit Cards – Research Participant Study).
  4. Ensure that the IRB number is entered into the “IRB Approval No” box.
  5. Fill in the Start Date and End Date of the study under the “Time Period” section.
    1. For Temporary Request mark “X” 3 months or less.
    2. For Replenishable Bank Account or Reloadable Debit Card Account mark “X” 1 year or greater.
  6. Fill in the custodian name and check payable information. Check payable will most likely be the custodian of the study. Fill in the building name, address, city, and state underneath the custodian name and check payable lines.
  7. Leave the “If address is different[…]” boxes empty unless the check’s intended delegate or address is different than the custodian address.
  8. Complete the “For additional information call” section with the contact name and phone number.
  9. Under the “Description/Amount Requested” section, provide a description of how the advance will be used. Fill in the Research Participant Study title, IRB Approval No., IRB Begin Date, IRB End Date, and provide a description of the project. If the operation is a Petty Cash Fund, provide a description of the operation under the respective section. If the operation is a Change Fund, provide a description of the operation under the respective section. Include the amount of requested advance for each operation needed.
  10. Confirm/enter the total amount of advance(s) from all requested operations in the “Total Amount Requested” section.
  11. Form is signed by the custodian. A delegate signature is also required if the check is not payable to the custodian.

Department/Unit

  1. Verify information on Steps 1-11.
  2. Department approver signs custodian fund accounting form.
  3. File original documents in department.
  4. Send copy(s) to the Dean’s/Division Office for approval.

Custodian/Department

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records.

Dean/Director’s Office

Keep a copy of Custodian Fund Agreement Form along with the Custodian Fund Request Form for internal records. Send original documents to Cash Management, 21 N. Park Street, Suite 5301.

Policy & Procedure

UW Policy 3012 – Custodian Fund Policy

Contact

Questions about this form can be sent to cstdnfnd@bussvc.wisc.edu.

Custodian Fund Agreement Form

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Use this form to request custodian funds for human subject studies, change funds, petty cash and contingent bank accounts. All Custodian Agreement must be completed by the Custodian and approved by the Department and Dean's Office before the advance is sent onto Cash Management for processing. All agreements must have a Custodian Fund Request Form and Custodian Fund Budget Information Form attached with this agreement.

Use this form to request custodian funds for human subject studies, change funds, petty cash, and contingent bank account.

Download the Custodian Fund Agreement Form (PDF)

Instructions

Custodian Funds are advanced only to authorized, permanent UW–Madison employees. The Custodian Funds are issued for a specific purpose and may not be used for any other purpose than expressed on the Custodian Fund Request Form.

All Custodian Funds must be reconciled monthly to authorized advance levels and properly accounted for within 30 days of the end of the advance period.

All Custodian Funds require, quarterly reporting, regardless of activity, to ensure advance levees are maintained by using the Custodian Fund Accounting Form.

Top paragraph: Fill in the dollar amount of the Custodian Fund and enter the same amount in the Custodian Fund Request Form. Enter begin and end dates of the Custodian Fund Request. Enter the Custodian Fund reference number which agrees with the Custodian Fund Request Form.

Individual Custodian Agreement paragraph: Enter the custodian name and ensure it agrees with the Custodian Fund Request Form. Include in this section, the Custodian telephone number, and the Custodian e-mail. The Custodian must sign and date this Custodian Fund Agreement before it can be reviewed for approval and processed.

Department Agreement paragraph: Filled in the Department name.

Bottom section of this agreement:

  • Print Name (Department Representative): Filled in with the name of the department representative.
  • Telephone Number (Department Representative): Fill in with the telephone number of the department representative.
  • Email (Department Representative): Fill in with the email address of the department representative.
  • Signed (Department Representative): This section must be signed and dated by the department representative.
  • Signed (Dean/Director): This section must be signed and dated by the Dean/Director.

Custodian/Department

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records.

Dean/Director’s Office

Keep a copy of the Custodian Fund Agreement along with the Custodian Fund Request Form and Custodian Fund Budget Form for internal records. Email documents to cstdnfnd@bussvc.wisc.edu or send to Cash Management, 21 N. Park St., Suite 5301, Madison, WI 53715.

Related policies and procedures

UW-3012 Custodian Funds Policy

Contact

Questions can be directed to cstdnfnd@bussvc.wisc.edu.

Check Shred Confirmation Form

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This memo is to inform Cash Management that all remaining checks for a Custodian Funds checking account have been disposed of by using a cross shredder or disposing of the checks in a confidential shred bin.

This memo is to inform Cash Management all remaining checks for a Custodian Funds checking account have been disposed of by using a cross shredder or disposing of the checks in a confidential shred bin.

Download Check Shred Confirmation (Word Doc)

Custodian Fund Accounting Form

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Use this form to record and account for program expenditures related to the Custodian Fund Request. Expenses using the custodian funds must agree with the original purpose of the Custodian Fund Request.

Use this form to record and account for program expenditures related to the Custodian Fund Request.

Expenses using the custodian funds must agree with the original purpose of the Custodian Fund Request.

Download Custodian Fund Accounting Form (Excel)