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Comptroller's Office
University of Pennsylvania
Suite 312 Franklin Building
3451 Walnut Street
Philadelphia, PA 19104
215.898.7593 (Phone)
215.898.0817 (Fax)

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Office of the Comptroller

[ Document/Forms ]

The following forms are available to download in Word, Excel or PDF formats. Unless specified the forms will be downloaded to the web browser's default directory.

Contact your local desktop support provider for assistance with obtaining and installing the Acrobat Reader for opening PDF forms and documents.

* Forms marked with an asterisk (*) are available to fill out on-line. Once filled out please print out the form and sign, if necessary, before forwarding them to the appropriate office. All other forms downloaded may be filled in neatly by hand or type.

Disbursements - Accounts Payable
Form Name Format Comments
PDA-ES Form (Employee/Student) MS Excel Workbook Used for Employees/Students and Foreign National Employee/Students for taxable payments
PDA-F Form (Foreign Non-Affiliates - Corporations/Individuals) MS Excel Workbook Used for all Foreign Corporation/Foreign Individuals or Non Corporate Entities and Foreign Drafts
PDA-NA Form (Non-Affiliates) MS Excel Workbook Used for Corporate Suppliers/Individuals or Non Corporate Entities
PDA-W Form (Wire Transfer) MS Excel Workbook Used only for payments over $100,000 or International Payments
Check Cancel/Stop Payment Request MS Word DOC  
1099 Worksheet for Non-BEN payments greater than $600 MS Excel Format  
Request for Reimbursement of Petty Cash Fund PDF* Form Updated 11/14/08
Excel 97-2003*
Guest Travel Reimbursement (GTR) Worksheet Excel (Download) Used with PDA-NA or PDA-F Forms
Honoraria Eligibility Certification Form PDF Foreign Visitors Honoraria Eligibility Certification Form
C-12 Independent Contractor Determination & Certification PDF  

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BEN
Form Name Format Comments
BEN Deposits
BEN Deposits Access Request Form PDF  
Word 97-2003
BEN Financials
Planning Access Request Form PDF  
BEN Financials Printer Registration Form eForm  
PDF Work Instructions
BEN Financials Access Request eForm eForm  
BEN Financials ID/Name Change Request eForm eForm  
DW Appl Login ID/Name Change Request eForm eForm  
Financial Training Registration Refer to the Registration section of the Financial Training website.
Enhancement Request Form PDF  
GL Feeder Request Form PDF  
Word 97-2003*
Email Feeder Request Form PDF  
Change Buyer Request Form PDF  
Word 97-2003*
BEN Reports
BEN Reports Access Request eForm eForm  

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Tax and International Operations
Form Name Format Comments
Excise Tax Templates
Hawaii Excel 97-2003
Sales Tax Templates and Matrices
Alabama Excel 97-2003  
Arizona Excel 97-2003  
Arkansas Excel 97-2003  
California Excel 97-2003  
Colorado Excel 97-2003  
Connecticut Excel 97-2003  
District of Columbia Excel 97-2003  
Florida Excel 97-2003  
Georgia Excel 97-2003  
Idaho Excel 97-2003  
Illinios Excel 97-2003  
Indiana Excel 97-2003  
Iowa Excel 97-2003  
Kansas Excel 97-2003  
Louisiana Excel 97-2003  
Maine Excel 97-2003  
Maryland Excel 97-2003  
Massachusetts Excel 97-2003  
Michigan Excel 97-2003  
Minnesota Excel 97-2003  
Mississippi Excel 97-2003  
Missouri Excel 97-2003  
Nebraska Excel 97-2003  
New Jersey Excel 97-2003  
North Carolina Excel 97-2003  
New York Excel 97-2003  
Oklahoma Excel 97-2003  
Pennsylvania Excel 97-2003  
Rhode Island Excel 97-2003  
South Carolina Excel 97-2003  
Texas Excel 97-2003  
Utah Excel 97-2003  
Vermont Excel 97-2003  
Virginia Excel 97-2003  
Wisconsin Excel 97-2003  
Pennsylvania Matrices
Construction Excel 97-2003/Word Penn Key and Password required
Master Excel 97-2003 Penn Key and Password required
Schools / Centers Excel 97-2003 Penn Key and Password required
Contact Joe Gibbs if you have any questions about the Appendicies and Matrices
joegibbs@upenn.edu           (215)898-1552
Tax Forms
Form Name Format Comments
FNIF PDF Foreign National Information Form
Form SS-5 PDF Application for a Social Security Card
Form W-7 PDF Application for IRS Individual Taxpayer Identification Number
Form W-8 Website Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding
Form W-9 PDF Request for Taxpayer Identification Number and Certification
CFSI PDF Certification of Foreign Source Income
2014 W-4 PDF Employee's Withholding Allowance Certificate
Tax Exemption Form PDF Application for Phila City Wage/PA State Taxpayer Exemption
PA Local Earned Income Tax Residency Certification Form PDF*  
FNIS Webpage Link to Foreign National Information System
Foreign Earned Income Exclusion PDF (IRS Form 673)
City Wage Tax
2013 City of Philadelphia Wage Tax Refund Instructions for Statement DOC  
2013 City of Philadelphia Wage Tax Refund Petition Form Website  
State W-4 Forms
Form DE4 (California) PDF CA Withholding Allowance Certificate
Form IL-W-4 (Illinois) PDF Employee Withholding Allowance Certificate
Form MW507 (Maryland) PDF Employee’s Maryland Withholding Exemption Certificate
Form M-4 (Massachusetts) PDF Employee’s Withholding Exemption Certificate
Form MI W-4 (Michigan) PDF Employee’s Withholding Exemption Certificate
Form W-4MN (Minnesota) PDF Employee’s Withholding Exemption Certificate
Form MO W-4 (Missouri) PDF Employee Withholding Allowance Certificate
Form W-4 (New Jersey) PDF Employee's Withholding Allowance Certificate for State of New Jersey
Form IT-2104 (New York) PDF Employee's Withholding Allowance Certificate
Form W-4 (North Carolina) PDF Employee Withholding Allowance Certificate
Form VA-4 (Virginia) PDF Personal Exemption Worksheet
Form D-4 (Washington, DC) Website Employee Withholding Allowance Certificate
Form D-4A (Washington, DC Non Resident) Website Certificate of Nonresidence in the District of Columbia
For questions pertaining to any of the forms in the Tax Forms section
please contact the Tax Department at tax@exchange.upenn.edu

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Financial Reporting
Form Name Format Comments
Account Reconciliation Preparation & Review Policy # 2704 PDF  
Reconciliation Summary Template Excel  
Receivable Aging Template Excel  
Suspense Monitor-aging Template Excel  

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General Accounting/Budget Office
Form Name Format Comments
New FUND Request Form PDF  
Request to Create/Change Organization (ORG) PDF  
Request to Create/Change Program (Prog) PDF  

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ISC Systems Access Forms
Form Name Format Comments
ACF2 Rule Request MS Word  
PDF
Administrative Mainframe Logon ID (includes PennWorks) MS Word Access to Payroll, PennWorks, SAM, SFSEASI, SRS, TSO, Focus, Natural
PDF
AIX script/software move MS Word  
PDF
ISC SEO Server and WFR Request Form MS Word  
PDF
Remedy Door Access MS Word  
PDF

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Payroll
Form Name Format Comments
Form I-9 PDF INS Employment Eligibility Verification
Graduate Student and Post Doctoral Appointment Information Form PDF You may also find the Definitions of FULL-TIME Graduate Student Appointment page helpful.
Word 95
Word 97-2003
Stop Payment Request Form PDF*  
Word 97-2003*
Payroll Stale Dated Check Form PDF  
Word 97-2003
Off Cycle Payment Request PDF  
Word 97-2003
Restricted Salary Reallocation Request PDF*  
Excel 97-2003*
Wage & Tax Statement Information PDF W2 Address Change
Word 97-2003
Request for Administrative Mainframe LOGON ID (includes PennWorks) PDF* Access to Payroll, PennWorks, SAM, SFSEASI, SRS, TSO, Focus, Natural
MS Word*
PennERS Access Request Form PDF*  
Word 97-2003*
Employee Information Form PDF*  
Word 97-2003*
Voluntary Self-Identification Form PDF  
Temporary/Hourly Time Reporting Form Excel 97-2003  
PDF
Request for Overpayment Calculation Word 97-2003*  
Required forms for Foreign National Students/Scholars Webpage Listing of Forms that are required for Nonresident Aliens

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Purchasing Card
Form Name Format Comments
Purchasing Card Application PDF (New Request or Change to Existing Card)
Single Transaction Limit Exception eForm  
Monthly Spending Limit Increase eForm  
Request to Delete Cardholder Account eForm  
Wright Express Fuel Card Cardholder Account Form PDF  

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Property Management
Form Name Format Comments
Equipment Change Form PDF To be completed when transferring ownership of equipment between schools/centers.
Word 97-2003
Authorization for Retirement of Equipment PDF To be completed for property items that will be disposed of.
Word 97-2003
Home and Remote Location Form PDF To be completed for University-Owned Property items that will be used at home.
Word 97-2003
Equipment Information Form PDF* To be completed by the school/center when assets are created in BEN Assets by PMG based Journal Entries and Cash Deposits or for setting up new Equipment in Process Assets.
Word 97-2003*
Donated Collectibles Form PDF To be completed by school/center when Gifts are processed through “Atlas Gift System”.
Word 97-2003

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Transaction Authorization Card (TAC)
Form Name Format Comments
Transaction Authorization Card (TAC) Request PDF  
Word (Doc)
Transaction Authorization Card (TAC) Process Description PDF  
Transaction Authorization Card (TAC) Guidelines for Determining Organization Assignment PDF  
Transaction Authorization Card – Special (TAC-SP) Process Descripton PDF  

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Travel and Expense
Form Name Format Comments
Concur Expense Access Request PDF This form is for UPHS & Agency Personnel that need access to Concur Expense
Excel (.xlsx)
Missing Receipt Affidavit Business Services Website  
Statement of Business Connection Business Services Website  
Foreign National Information Form (FNIF) Business Services Website  
campus

Comptroller Spotlights

FY2014 Closing Instructions
New Category Codes
GL Object Codes FY2015
Concur Expense Type/Object Code Matrix (2015)

Comptroller Offices

Accounting
Accounts Payable
BEN
Tax and International Operations
Payroll
Travel
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