ASI IRA Check Request

Instructionally Related Activities (IRA) Check Request
** It is the organization's responsibility to read the instructions and ensure that all summited requests are complete. Incomplete check requests will not be accepted **

Please contact the ASI Business office at asiaccounting@csus.edu or at (916) 278-2231 for any questions or concerns.
PARTY TO BE PAID:
Vendor Full Name*
Party to pay/reimburse
Total Amount to be Paid:*
ex: $19.56
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
(123) 456-7890
E-mail*
example@example.com

IRA Information
Department Name*
Department #*
Please type in your 2-digit department # (For Dept 72, please include 4-digit program #)
IRA Grant Allocations

2110 - Outside Services (Honoraria, Speaker/Performer fees, etc.)

2200 - Program Supplies

2201 - Mileage Reimbursements

2300 - Facility Rental

2600 - Promotion

2610 - Printing

2700 - Awards

2800 - Travel

2810 - Conference Registration

2820 - Meeting Expenses

3010 - Postage

3020 - Copying
Please type in the GL accounts to expense, per your granted allocations, followed by the amount per account.
GL#      Amount:
GL#      Amount:
GL#      Amount:
GL#      Amount:
Ex: GL#: 2200 Amount: $5.00

IRA Documentation

Please attach the necessary documentation based on the type of Check Request
Please provide a brief descriptions of the expenses:*
** PLEASE WRITE-IN IF AN INVOICE IS PAYING OFF AN IRA P.O. (for encumbrance liquidation purposes) AND REFERENCE THE P.O. #
IF APPLICABLE, please submit the following:

- Invoice/Receipts

- Proof of Payment for Reimbursements*

- Proof/Confirmation of Delivery if items are being Shipped

- List of attendees for any Food, Membership Registration/Dues purchases

- Proof of Conference for any Conferences (itineraries, brochure, name tags, pictures at the event, etc.)

- Google Maps (or other map) for total distance traveled for mileage reimbursements

- for Contracted Services:

a. Direct Payment Request (DPR)

b. Memorandum of Agreement (MOA)

c. W9 from the party providing services

* If receipts show the last 4 digits of the Credit Card used, attach an image of that CC showing only the last 4 digits and full name (example below). If receipts do not show the last 4 digits of the Credit Card used, attach a bank statement/report showing the transaction charges and full name. Please block out any visible account numers.
Please attach necessary documentation(s):*

Cancelof

IRA Authorization
Signature*

Clear
Name of Authorized Signer*

First NameLast Name
Phone Number*
(123) 456-7890
Email*
You will receive a notification to this email upon submission and approval

Instructionally Related Activities (IRA) Check Request