GASB 96 Information Request Form
GASB 96: Subscription-Based Information Technology Arrangement
Use this form to provide information for all contracts or agreements with a third party for IT software, alone or in combination with a tangible capital asset as specified in the contract for a period more than 12 months,including any extension options or termination clauses.
Section 1: Department Information
Business Manager
*
First Name
Last Name
Department Name
*
Contact
*
example@example.com
Chartfield(s) for Contract Charges
*
Operating Unit
Department
Fund
Class
PC Business Unit
Project
% Allocation and/or Amount
Chartfield1
Chartfield2
Description of the Agreement
*
Section 2: PeopleSoft Information
Provide at least one of the following:
*
Number
Requisition
Purchase Order
Voucher
Vendor Name
*
Section 3: Agreement Terms
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Stated Interest Rate, if available
Renewal Options
If yes, Renewal Period
If yes, Intention to exercise
Yes
No
Termination Clause
Contract contains a Termination Clause
Yes
No
If yes, Terms of Termination Clause
If yes, Intention to exercise
Yes
No
Section 4: Agreement Amounts
Initial Implementation Total Cost
Operational Payment Total Cost
Maintenance / Training Total Cost
Value of Equipment, if agreement includes physical assets
Required: Please attach a copy of the signed Agreement and complete one form per agreement.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
Continue
Continue
Should be Empty: