WEST VIRGINIA DEPRTMENT OF TRANSPORTATION/DIVISION OF HIGHWAYS
EXAMPLE OF AN ACCEPTABLE INVOICE FORMAT
*ORIGINAL LETTERHEAD STATIONERY OF RESEARCH INSTITUTION (and 4 copies)
Current Date
Voucher #___ Progress
Research Institution Tracking #
Research Institution Award #
TO: James E. Sothen, P. E.
Acting Deputy State Highway Engineer/Development
West Virginia Department of Transportation
Division of Highways
Building 5, Room A-129
Charleston, WV 25305-0430
FROM: (Day/Month/Year – Day/Month/Year)
PROJECT: (WVDOT/DOH Project Title and Project Number)
SALARIES:
(Period of Work) - Name of each person who worked on the project during the $ (Amount)
dates listed; title of person; monthly salary rate; and total
hours (or percentage of total monthly hours) worked.
FRINGE BENEFITS:
____% for non-students or Principal Investigators $ (Amount)
____% for Graduate Research Assistants $ (Amount)
____% for students $ (Amount)
Salary Subtotal: $ (Amount)
EQUIPMENT:
Exact description of each item purchased is required; must attach purchase order $ (Amount)
or vendor receipt. Purchase of equipment in excess of $500.00 must be requested
in writing or specified in the original work proposal.
SUPPLIES:
Must itemize and clearly identify each item purchased. $ (Amount)
TRAVEL:
All in-state travel must be specified as such. Any out-of-state travel must also be $ (Amount)
specified as such; out-of-state travel must be approved by the WVDOT/DOH prior to
occurrence of the travel.
OVERHEAD:
Overhead at the percent established by the US Department of Health and Human Services’ $ (Amount)
Audit Agency for the Contractor during the official period of the project.
TOTAL BILLING: Total Amount Invoiced: $ (Amount)
Total Previous Billing: $ (Amount)
Total Invoice to Date: $ (Amount)
Total Amount Authorized: $ (Amount)
Less Total to Date: $ (Amount)
Balance of Funds: $ (Amount)
“I certify that items included herein as direct costs have been excluded from all indirect costs”
______
Principal Investigator Accountant Date
Yes or No Have monthly progress reports been submitted to the WVDOT/DOH for the period reflected on this invoice ? (To be indicated by the Principal Investigator)