Petty Cash Administration Form
Petty Cash Fund # (if known)
School or Administrative Area.
Dept Phone Number
Instructions:
1) Fill in the appropriate section as chosen, then PRINT. Use a separate form for each Petty Cash fund.
2) Make sure each section filled out has an appropriate DAF signature. Make a photo copy for your records.
3) Scan original signed form, along with any required attachments, and email to
pettycash@columbia.edu if you don't have a scanner, email for instructions. Please allow 2 weeks for processing. Custodian will receive an email confirmation when action is completed. Please direct questions to
pettycash@columbia.edu. [Important Note: CUMC departments should send all PC
establishment requests and fund increase requests (only) to Deputy Controller for Internal
Controls & Compliance, 630 W. 168th Street, P&S 2-460, CUMC
or email to rm2698@columbia.edu.]
Choose One:
To Establish a New Petty Cash Fund
To Increase (or Decrease) a Petty Cash Fund
To Change a Petty Cash Custodian
To Close a Petty Cash Fund
To Change a Project # on a Petty Cash Fund

To Establish a New Petty Cash Fund

Name of Fund Custodian (Type in full name - must be full time officer or staff employee)
Title of Custodian
 
UNI of Custodian
Department Name
 
Department Number
Office Mailing Address
 
Mail Code
Project # for Petty Cash Fund
(i.e. UR005896)
 
Dollar Amount of Fund

Location of Fund (where it will be secured -
i.e. address of dept. office, field office, etc.)

 
Method of Securing Fund
(i.e. secured locked box, safe, etc.)
Reason for the fund (be specific, include business purpose plus grant title & number, plus other info as required if applicable. max 7 lines, only what is visible will print).

IRB Approval #(for human subjects PC accts only)  
DAF Approval Signature (Dept head or PC designated DAF)Date


Print DAF Approver Name

Attach completed and signed Custodian Consent Form. Note: Custodian will not receive initial PC check until successful completion of online training. (CUMC departments should send all fund establishment documents to CUMC Office of the Controller.)


CUMC Office of the Controller Approval (Required of all CUMC PC Funds ONLY.)


 
To Increase (or Decrease) a Petty Cash Fund

Name of Fund Custodian (Type in full name)
Department #
 
UNI of Custodian
Current Amount of Fund
 
Amount of Increase (or Decrease)
Project # for Petty Cash Fund
(i.e. UR005896)
 
Target Amount of Fund
(total after increase/decrease)
If target amount of fund will be over $500, explain here, in detail, reason for increase (max 7 lines, only what is visible will print, attach additional explanation sheet if necessary).
DAF Approval Signature (Dept head or PC designated DAF)Date


Print DAF Approver Name

For decrease only, attach Cash Module "Cash View" print-out from Bursar Teller showing amount deposited into ARC. (CUMC departments should send all fund increase requests to CUMC Office of the Controller.)

CUMC Office of the Controller Approval (Required of all increases of CUMC PC Funds ONLY.)


 
To Change a Petty Cash Custodian

Name of NEW Fund Custodian (Type in full name - must be full time officer or staff employee)
Title of New Fund Custodian
 
UNI of New Fund Custodian
Department #
 
Name of OLD Fund Custodian
Office Mailing Address
 
Mail Code
Project # for Petty Cash Fund
(i.e. UR005896)
 
Dollar Amount of Fund

DAF Approval Signature (Dept head or PC designated DAF)Date


Print DAF Approver Name

Attach completed and signed Reconciliation Form.
 
To Close a Petty Cash Fund

The custodian of a Petty Cash Fund must close the fund immediately if the purpose for which the fund was established ends or changes significantly. Please refer to the CU Petty Cash Policy for additional information.
Name of Fund Custodian
Department Name
 
UNI
Project # for Petty Cash Fund
(i.e. UR005896)
 
Dollar Amount of Fund

I certify that this Petty Cash Fund has been reconciled according to policy and approved by the appropriate DAF. A copy of the reconciliation will be maintained by our department for future auditing purposes. I've attached all required documents to close out this petty cash form.
Custodian Signature Date


DAF Approval Signature (Dept head or PC designated DAF)Date


Print DAF Approver Name

Attach completed and signed Reconciliation Form.
Attach Cash Module "Cash View" print-out from Bursar showing any cash amount deposited into ARC.
Create a petty cash close out voucher in ARC.
See PC Info website for detailed instructions.

 
To Change ARC Project # on a Petty Cash Fund

Name of Fund Custodian (Type in full name)
Department #
 
UNI of Custodian
Current Amount of Fund
 
 
Current ARC Project # on Petty Cash Fund
 
New ARC Project # on a Petty Cash Fund
Start Date of Current Project
 
Start Date of New Project
 
End Date of Current Project
End Date of New Project

(See ARC for this info. Account Start and End Dates are of particular importance for project or grant accounts.)

Comments
DAF Approval Signature (Dept head or PC designated DAF)Date


Print DAF Approver Name