Form 88-104 - Texas Species Research Reimbursement Request Cover Sheet - Economic Growth And Endangered Species Management Division - Texas Comptroller Of Public Accounts

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Texas Comptroller of Public Accounts
88-104
(1-16)
Economic Growth and Endangered Species Management Division
Texas Species Research
Reimbursement Request Cover Sheet
Interagency cooperation contract number (IAC number)
University name
Species name
Period covered by report
Month
Day
Year
Month
Day
Year
From
Through
Total amount of request
University invoice number
Itemization of Charges by Budget Category Per IAC
All charges must be accompanied by detailed documentation/receipts and a description of which project tasks they were related to. No confidential
data should be submitted with the reimbursement requests. Please see General Instructions documents (Attachment I) for further details.
Budgeted Amount
Requested Amount
Remaining Amount
Subcontract (if applicable) ......................... $ ___________________
$____________________
$ ___________________
Personnel ............................................
.....
$ ___________________
$____________________
$ ___________________
Travel........................................................
.
$ ___________________
$____________________
$ ___________________
Supplies & Materials................................
..
$ ___________________
$____________________
$ ___________________
Other.........................................................
.
$ ___________________
$____________________
$ ___________________
Total Direct Costs ......................................
$ ___________________
$____________________
$ ___________________
Indirect Costs............................................
.
$ ___________________
$____________________
$ ___________________
TOTAL .....................................................
.
$ ___________________
$____________________
$ ___________________
Percentage of Funds Expended to Date for Contract .................................................................................. $ ___________________
Notes
Transfer of funds between Direct Cost (DC) categories shall not exceed ten percent (10%) of a remaining budgeted DC category without a contract
amendment. Transfers between DC categories less than 10 percent is permissible without contract amendment, but requires preapproval from Comptroller.
Approval will not be unreasonably withheld. Any amount transferred between categories must be documented and submitted reflecting the changes.
Please submit invoices to species.research@cpa.texas.gov.
Principal Investigator Certification
I certify that the provided information is true and correct to the best of my knowledge based on diligent inquiry.
Print name
RECEIVED
SIGNATURE
DATE
Date
Accounting Certification
I certify that the provided information is true and correct to the best of my knowledge based on diligent inquiry.
Print name
Contact phone (Area code and number)
Contact email address
Date

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