Form

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 Workday FDM values 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.
    • For Temporary Request mark “X” 3 months or less.
    • For 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 5270.

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 5270, 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)

Volunteer Driver Authorization Request Form

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Volunteer Driver Form

Volunteers who do not have a NetID and who are eligible to become an authorized driver must work with their supervisor to complete this UW–Madison Volunteer Driver Authorization Request Form.

The supervisor must email a copy of the Volunteer Appointment Letter along with the completed UW–Madison Volunteer Driver Authorization Request form to driverauth@bussvc.wisc.edu.

Applicants and supervisors will be notified of approval/denial within 10 business days via email.

Download the UW–Madison Volunteer Driver Authorization Request Form (PDF)

Lightning Losses Affidavit Form

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Lighting Losses Affidavit document

This form must be completed for property claims of damages caused by lightning to UW–Madison owned property, equipment, or other contents. Learn more about filing property damage claims

The Lightning Losses Affidavit form must be completed by a repair firm/person and signed by the department representative. Submit the completed form to Risk Management (propertyclaims@bussvc.wisc.edu).

Download Lightning Losses Affidavit Form (PDF)

Internal Third Party Authorization Form (Employee)

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This form is intended to be used for employees that are enrolled in a course for job-related training only.

Used for authorizing internal third party payments for employees that are enrolled in a course for job-related training only.

Download Internal Third Party Authorization Form: Employee (xlsx)

Instructions

This form is intended to be used for employees that are enrolled in a course for job-related training only. To qualify as job-related, the training/course must be: Required by the employer or required as a condition to the retention of an established position or status (e.g., continuing professional education courses), taken to maintain or improve skills required in the employee’s present work, or Post Grad Trainees (Post Doc trainees are non-employee).

DO NOT INCLUDE: Training taken to meet minimum educational requirements for employment; training that will qualify the employee for a new trade or business; registration fees for professional meetings, conferences, conventions, etc. Please refer to General Administrative Policy G25 for additional information about Career Related Educational Assistance.

By submitting this form you are verifying that the UW Madison employees listed qualify for job-related training reimbursement.

  1. Submit a separate form for each semester. Do not mix terms. Submit a separate form if you intend to have more than one contract for the term. Download a new spreadsheet each semester (we update the forms throughout the year). Be aware, Spring semester third party deferrals do not automatically roll over to Summer….a new Summer form must be submitted.
  2. Department Name—Refer to your last third-party invoice. The Department name listed on the authorization form you are submitting must match the name of the Department to be invoiced.
  3. Billing Address—Your department’s physical location.
  4. Contact NameContact Phone – Email—List whom we can contact for any questions pertaining to the authorization form submitted as well as the invoice. If you submit more than one contact name, the first person listed will be considered the main contact. The third-party tuition invoice will be forwarded to the email listed for the main contact.
  5. Term Code—Refer to the Term Code pattern listed on the form at the website.
  6. Indicate what the department intends to cover—Select the charges to be covered by this contract.
  7. Special Instructions— Indicate change or cancelations.
  8. Student name LAST & Student name FIRST— The name you enter on the form should match the student’s name in SIS.
  9. Campus ID— Campus ID needs to be entered for each student. We do not have access to PeopleSoft Payroll ids.
  10. List dollar limit/limitations— if applicable.
  11. If you would like to remove/cancel a student from a third-party contract:
    • It is the department’s responsibility to notify a student that their third-party contract has been canceled and that the student is now responsible to pay their tuition and fees.
    • Do not mix authorizations with cancellations on the same form; submit a separate form for cancellations only. Complete the form for cancellations using the same instructions in 2-9 above.
    • Enter cancellation & reason in the “Special Instruction” box
  12. You must save a copy of the authorization form on your local drive. When deciding on a name for the form, make reference to your department in the file name along with “TPAuth” or “TPCancel.“
  13. Submit the file using the Bursar’s Office Secure Website.

How to upload your Form

  1. Go to the Bursar’s Office Secure Website
  2. Login using your NetID.
  3. Add the name of your department in the first entry box.
  4. Select “Third Party Authorization Forms”.
  5. Select the file to upload.
  6. Select “Submit Form”.

Contact Information

Bursar’s Office—Third Party Billing
333 East Campus Mall #10501
Madison, WI 53715-1383

thirdparty@bussvc.wisc.edu
608-262-3612