UAB Financial Affairs

Forms are updated routinely and departments should NOT bookmark or print a specific version.

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Form Name	Category	Department	This Form Is Used For	Format
2012 W2 Balancing Worksheet	-	Payroll		MSEXCEL
Accountable Equipment Officer and Authorized Signors	-	Equipment	This form is used to designate the departmental contact for equipment inventories and also to identify other personnel authorized to transfer or dispose of the department's equipment.	PDF
Addendum to Agreement for Clinical Affiliation	-	University Contracts
Affiliation for Clinical Education	-	University Contracts
Affiliation for Preceptorship Education	-	University Contracts	This form is used for establishing affiliation agreeements for preceptorship education.
Airline Ticket Request	-	Expenditure Review Services	This document provides detailed instructions on creating an Airline Ticket PO Requisition for tickets issued by ADTRAV.
Alabama Employee's Withholding Form: A-4	-	Payroll	form is used by employees to adjust their state tax withholdings. Please complete the form and fax to Payroll Services (205) 975-7417.
Alys Stephens Center Contract Routing Form	-	University Contracts	This form is used as the cover sheet for contracts between the Alys Stephens Center and external parties.
Amendment to Fully Executed Agreement	-	University Contracts	This form is used to alter a fully executed agreement between UAB and an external party.
At Risk/Pending Account Request	-	Grants	This form is used to request an "At Risk" or "Pending" account for sponsored activity where the legal agreement has not been finalized	PDF
Bar Code Forms	-	Financial Affairs
Budget Modification	-	Budget	Used when adjusting revenue and expense in a budgeted account; also to be used when actual dollars/funds are being transferred to or from a budgeted account	VND.OPENXMLFORMATS-OFFICEDOCUMENT.SPREADSHEETML.SHEET
Business Associate Agreement	-	University Contracts
Car/Van Rental Form	-	University Contracts	This form is used to seek approval for a direct bill agreement for vehicle rental.
Cash Receipt-American Express	-	Accounting	To prepare Departmental Deposits of processed American Express transactions remitted to either General Accounting or the Cashier's Office	MSEXCEL
Cash Receipt-Cash	-	Accounting	To prepare Departmental Deposits of cash remitted to either General Accounting or the Cashier's Office	MSEXCEL
Cash Receipt-Checks	-	Accounting	To prepare Departmental Deposits of checks remitted to either General Accounting or the Cashier's Office	MSEXCEL
Cash Receipt-Discover	-	Accounting	To prepare Departmental Deposits of processed Discover transactions remitted to either General Accounting or the Cashier's Office	MSEXCEL
Cash Receipt-Mastercard	-	Accounting	To prepare Departmental Deposits of processed Mastercard transactions remitted to either General Accounting or the Cashier's Office	MSEXCEL
Cash Receipt-Visa	-	Accounting	To prepare Departmental Deposits of processed Visa transactions remitted to either General Accounting or the Cashier's Office	MSEXCEL
Certificate of Screening	-	Accounting	Certifcation there is not equipment already located on campus that can be used for the grant or contract award	PDF
Cost Sharing Commitment Form	-	Grants	Used to document cost sharing commitments
Cost Transfer Form	-	Accounting	To request transfer of expenditures between accounts in accordance with the cost transfer policy	PDF
Dev Program - Additional Assignment	-	Payroll	Video of how to process ACT document for development or university program participants for current students/employees	VIDEO/X-MSVIDEO
Dev Program - New Hire or Rehire	-	Payroll	Video of how to process ACT document for development or univeristy program participants that have no employment relationship to UAB	VIDEO/X-MSVIDEO
Disability Application	-	Student	Borrower must complete to apply for disability cancellation
Effort Report Policy ACT Checklist	-	Payroll	ACT documents with a retroactive effective date prior to the effort report rolling date or submitted on employees with delinquent Effort Reports require Payroll Services to flag the conversation on the document prior to the Submit. The flag is to assist in complying with the Effort Report Policy and review for new charges to reportable A21 accounts. Please complete the form below and fax to Payroll Services (205)975-7417.	PDF
Electronic Payment Request	-	Treasury
Emergency Purchase Order	-	Expenditure Review Services	This form is used to request an Emergency Advance Purchase Order.	PDF
Employee Intra-State Travel	-	Expenditure Review Services	Effective Jan 1, 2007 - Dec 31, 2007
Employee Intra-State Travel	-	Expenditure Review Services	Effective Jan 1, 2008
Employee Out-of-State Travel	-	Expenditure Review Services	Effective Jan 1, 20007 - Dec 31, 2007
Employee Out-of-State Travel	-	Expenditure Review Services	Effective Jan 1, 2008
Equipment Disposition Form	-	Equipment	The Equipment Disposition Form must be completed whenever equipment is moved. It is a 3-part form that is not available on-line. Please contact the Equipment Accounting Department at 934-5144 to obtain this form
Equipment Purchase Information	-	Equipment	Required for capital equipment purchases and used to indicate contact, affiliation, location, and other pertinent information about the equipment	PDF
Escrow Calculation Form	-	Payroll	Assisting 9-mo employees in calculating escrow amounts	MSEXCEL
Event Approval Form	-	Accounting	Used to request approval for Events	PDF
Excess Insurance Worksheet	-	Payroll		MSEXCEL
Federal Employee Withholding Allowance Form: W-4	-	Payroll	Used by employees to adjust their federal withholdings. This form is completed via the Adminsystem Self Service. For instructions please go to: http://tinyurl.com/4xf6pu
Federal Perkins Loan Request for Cancellation	-	Student	Borrower must complete to apply for postponement and/or cancellation of Federal Perkins Loan
Foreign Travel Approval Form	-	Expenditure Review Services	This form is used to request approval for business travel in a foreign country.
Grant Related Income Balance Carry Forward Request	-	Grants	Submitted to request carry forward of Grant Related Income balance	PDF
Grant Transfer of Petty Cash Fund	-	Grants	Used to request transfer of petty cash fund to new grant	PDF
Grants and Contracts Accounting Receipt Form	-	Grants	To prepare Departmental Deposits of funds remitted to Grants Accounting	PDF
Group/Travel Advance Agreement	-	General	For Student Group/Team Travel Advance Only	MSWORD
Guest Reimbursable Expenses	-	Expenditure Review Services	This information should be provided to guests prior to their arrival in Birmingham	PDF
Guest Travel Template	-	Expenditure Review Services	This form should be provided to all UAB guests (speakers, volunteers and recruits) to capture travel related expenses	PDF
Hardship Form	-	Student	Borrower must complete to apply for hardship deferment
Health System Contract Routing Form	-	University Contracts	This form is used to route hospital and health system contracts for signature.
Hotel PO Guest Form	-	Expenditure Review Services	This form is required to request a PO for Birmingham based hotels for volunteers, recruits, or guest speakers.	PDF
Huntsville Contract Routing Form	-	University Contracts	This form is used to route Huntsville contracts for signature
Incentive Form For Research Subjects	-	Grants	Used to request acquisition of incentives for Research Subjects of a Sponsored Project	PDF
Indirect Cost Revenue Redistribution Agreement	-	Grants	This form is used to redistribute indirect cost revenue among departments
IPOD, PDA, IPAD Wireless Service Request for Approval Form	-	Expenditure Review Services	This form is used to request wireless devices that require data capable service plans that are not provided by UAB Telecommunications. All other devices should be requested by contacting UAB Telecommunications directly.	PDF
IRS Determination Letter	-	Tax	Letter from Internal Revenue Service regarding tax exempt determination related to UAB	PDF
Loan Cancellation Request Form	-	Student	This form is used by students wishing to cancel any portion of a current disbursement of their Federal Subsidized Student Loan, Federal Unsubsidized Student Loan, Federal PLUS Loan, Federal Perkins Loan or other loans.	PDF
Loan Forbearance	-	Student	This form is used by students to request a loan forbearance	PDF
LPO Authorization Form	-	Expenditure Review Services	This form is used to obtain approval for the use of Limited Purchase Orders	PDF
LPO Pick Up Form	-	Expenditure Review Services	This form is used to identify departmental personnel authorized to pick up Limited Purchase Orders.	PDF
Moving Estimate Form	-	Procurement Contracts	This form is used to request an estimate for moving.	PDF
New Account Request	-	Accounting	To request Oracle GL and GA Grant Related Income Accounts	MSWORD
New Supplier Request Form	-	Procurement Contracts
New Supplier Spreadsheet	-	Procurement Contracts
Object Code Request Form	-	Accounting	To request a change to the Oracle Object Code Listing	MSWORD
Oracle Recurring Payment Request Form		Accounts Payable	To request recurring payments	MSWORD
ORC Review Request	-	Cost Analysis	This form is used to make changes in % effort through the UAB Office of Research Compliance.	PDF
Org Change Checklist	-	Accounting	This form is used to assist departments with changes in org structure	PDF
Org Code Request Form	-	Accounting	To request a change to the Oracle Org Listing	PDF
Out of State Advantage Direct Deposit Change Form	-	Payroll	Payroll direct deposit is required for all UAB employees including those working outside the state of Alabama. Out of state employees are required to complete an Advantage Payroll Services Direct Deposit Form.	PDF
Out of State User Work Location Checklist	-	Payroll	ACT documents with the proposed work location of Out of State, we have added a pre-submit process to ACT requiring this form to be completed. The purpose of this information is to determine the correct tax reporting. Please complete the form and fax to Payroll Services (205) 975-7417.	PDF
Out of USA User Work Location Checklist	-	Payroll	ACT documents with the proposed work location of Out of USA, we have added a pre-submit process to ACT requiring this form to be completed. The purpose of this information is to determine the correct taxation, tax reporting, and composite fringe rates for these employees/trainees. Please complete the form and fax to Payroll Services (205) 975-7417.	PDF
Payment Action Form	-	Accounting		PDF
Payment Requests and Object Code Edits	-	Expenditure Review Services	This provides a listing of allowable and unallowable object codes by payment request type.	MSEXCEL
Payment Requests Supplement Forms	-	Accounts Payable
Personal Services Form (Revised 2012)	-	Tax	Used to apply for an individual or employee to be paid as an Independent Contractor per UAB's Personal Services Policy	PDF
Petty Cash and Change Fund Agreement	-	Accounting	Required to be completed upon establishment of petty cash funds	PDF
Petty Cash and Change Fund Agreement Change of Custodian	-	Accounting	To be completed and submitted to request a change of Petty Cash Custodian	PDF
Petty Cash Fund Request	-	Accounting	Used to request establishment of petty cash funds	PDF
Petty Cash Reconciliation	-	Accounting	Reconciliation form to be completed and submitted quarterly to General or Grant Accounting	PDF
Petty Cash Termination	-	Accounting	Used to terminate petty cash fund	PDF
Position Description Questionnaire	-	Budget	Used to provide necessary information for the proper classification of a position and the effective recruitment, interviewing and selection of candidates for employment. Link to HR Compensation for official form;
Position Request Form	-	Budget	Used to establish a new position or to refill a vacant position as part of the recruitment process. Link to HR Compensation for official form
Rebudgeting Request	-	Grants	To request rebudgeting of sponsored award
Residual Closeout Request	-	Grants	To request closeout of fixed price account to residual account	PDF
Routing Forms	-	University Contracts	The appropriate routing form should be submitted as the cover sheet to any agreement processed through University Contracts.
Sample LPO Form	-	Expenditure Review Services	Limited Purchase Order forms may be picked up in Accounting Services (AB 620).	PDF
Sample PO	-	Expenditure Review Services	Sample Purchase Order	PDF
School of Dentistry Contract Routing Form	-	University Contracts	This form is used by the School of Dentisty for contracts with external parties.
Service Center Equipment Depreciation Waiver	-	Accounting	To request a waiver of depreciation of service center affiliated equipment.	PDF
Service Center Equipment Reserve Request for Transfer	-	Accounting	To be used to request a transfer of funds from a service center equipment reserve.	PDF
Service Center Interface Privileges	-	Accounting	Used to request Service Center Interface Privileges in accordance with the Oracle Service Center Interface procedures.	MSWORD
Service Center New Account Request Form	-	Accounting	To request a new Service Center account.	MSWORD
Severance Pay Tax Exemption Qualification	-	Payroll	Lump Sum Severance Payments	PDF
Social Security Form SSA-131	-	Payroll	Employer reporting to the Social Security Administration special wage payments made to an employee for a prior year.	PDF
Sole Source Justification Form	-	Procurement Contracts	This form is used to provide a clinical or technical justification of sole source.	PDF
State Nursing Scholarship Request for Cancellation	-	Student	Borrower must complete to apply for cancellation of State Nursing Scholarship	PDF
Stop Payment Request Form	-	Payroll	Stop payment on check issued through Payroll Services	PDF
Student Affairs Contract Routing Form	-	University Contracts	This form is used for contracts between Student Affairs and external parties.
Student Loan Forbearance	-	Student	Borrower must complete to apply for repayment forbearance.
Sub Recipient Invoice Certificate -Sub Recipient Personnel	-	Grants	Included with invoices submitted for sub recipient payment, per Sub-Recipient Agreements Policy (UAB)	PDF
Sub Recipient Invoice Certificate -UAB Personnel	-	Grants	Included with invoices submitted for sub recipient payment, per Sub-Recipient Agreements Policy (Non-UAB)	PDF
Tax Exemption Certificate	-	Tax	This form may be sent to any outside party seeking validation of our tax exempt status	PDF
Temporarily Alter Salaried Employee Pay	-	Payroll		PDF
Trainee Determination Checklist	-	Payroll	Used to determine if a non-US citizen will apply for an individual tax identification number (ITIN) or social security number (SSN)	PDF
University Routing Form	-	University Contracts	This form is used to route University contracts for signature.
Vehicle Purchase Approval Form	-	Business Services	This form is required to purchase a vehicle for UAB business.
Vendor Application Form	-	Procurement Contracts	This form is used by vendors seeking to become a valid supplier for UAB	PDF
Visa Participant Debit Card Log	-	Accounting	The log should be submitted when cards are ordered to track the card issuance	PDF
Visa Participant Incentive Debit Card Approval	-	Accounting	This form is submitted with each order; this form also indicates the quantity and denomination of amount of cards needed	PDF
Visa Participant Incentive Debit Card User Application	-	Accounting	This form is submitted with each order, and also used to track any changes.	PDF
W-9 Form - Blank	-	Expenditure Review Services	This form is required to set up US-based individuals or companies as a supplier in Oracle.
W-9 Form for UAB	-	Tax	Signed W-9 with UAB Tax ID	PDF
W8-BEN	-	Expenditure Review Services	This form is required to set up non-US individuals as suppliers in Oracle
Work Study Request Form	-	Payroll		PDF
Work-Study Placement Form	-	Payroll		PDF