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