Division of Business Services

Custodian Fund Request Form

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

Download Custodian Fund Request Form (Excel)

Download Focus Blue Custodian Fund Request Form (Excel)

Steps to take to complete the Custodian Fund Request Form

  1.  Fill in the top row of the Custodian Fund Request Form. 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 or Change Fund.)
  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 mark “X” 1 year or greater
  6. Fill in the custodian name and check payable information. Check payable will 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 “Deliver To” box empty unless it is different than the Custodian Address.
  8. Complete the “For additional information call” and “Phone” section.
  9. Under the “Description/Itemized Budget” 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.
  10. In the “Amount” section enter the amount of the advance that will be used for the operation.
  11. Form is signed by 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 Custodian Fund Request Form along with the Custodial Fund Agreement for internal records.

Dean/Director’s Office

Keep a copy of Custodian Fund Request Form along with the Custodian Fund Agreement for internal records. Send original documents to Cash Management, 21 N. Park Street, Suite 6101.

Policy & Procedure

UW Policy 3012 – Custodian Fund Policy

Contact

cstdnfnd@bussvc.wisc.edu