SAM – DISBURSEMENTS
REMITTANCE ADVICE 8422.3
(Rev. 9/9614)
A Remittance Advice, Std. Form 404C or other approved rRemittance aAdvice, will be prepared for each payee listed on a claim schedule.
The original copy(first copy) of the remittance aAdvice will be placed in a Remittance Advice Envelope, Std. Form 403 (See SAM sSection 8422.4), separated and in the same order as listed on the claim schedule. The duplicate (pink) copy will be filed in the department’s agency accounting office alphabetically by claimant's name. The vendor/payee's correct name and address will be clearly printedtyped on each rRemittance aAdvice in a position to permit the information to appear through the window envelope in which the warrant is mailed. In addition, the following information will be entered on the rRemittance aAdvice form: (1) department agency, name and organization code,Uniform Code Manual Agency Code Number (2) claim schedule number, (3) date of invoice date, (4) invoice number (purchase order number or contract number if invoice is unnumbered), (5) amount of invoice amount, and (6) total payment amount if more than one invoice. DepartmentsAgencies should use care to type the vendor/payee's name consistently on the cClaim sSchedule and rRemittance aAdvice for each and every payment. DepartmentsAgenciesshouldneed not enter their address below their name but may do so to enableso inquiries tocan be directed to them more quickly.
Only when the payment is aconsidered reportable one (see SAM sSection 8422.19) will the three boxes at the bottom of the form be completed. Warrant numbers will not be shown on any copies of the rRemittance aAdvice form. Reference to individual invoice dates, numbers, and amounts, items (3), (4), and (5) above may be omitted where some other means of notifying the vendor is provided.
The original of the rRemittance aAdvice and the applicable warrant will be mailed to the vendor/payee by the Office of the State Controller’s Office (SCO). Remittance Aadvisces will provide for delivery of warrants to andepartmentagency or department employees only whenre the departmentagency is the vendor/payee or for delivery to agency employees. (See SAM sSection 8422.6.) The rRemittance aAdvice will provide the payee with an identification of the payment. The SCOOffice of the State Controller will send a Controller's Notice of Claim Paid, Form CD–102, to the departmentagency for every cClaim sSchedule for which warrants were drawn.
Enclosures attached to rRemittance aAdvices are to be kept to a minimum and when necessary, will be folded to warrant size, (7 x 3 1/2 inches), and securely stapled behind the rRemittance aAdvice form. Material that cannot be folded to warrant size will be mailed separately by the departmentagency. Special arrangements must be made with SCOthe Office of the State Controller for continuing or large-scale problems. Normally, invoices will be adequately identified on the rRemittance aAdvice and requests shown on invoices with request asking their return will be ignored. Theexception to this rule concerns vendor requests for the return of punched cards orinvoice stubs so they can serve as machine-readable input to an automated data processing system. Such items will be returned and the related remittance advice usually need not list the invoices or show any other detailed information.
(Continued)
Rev. 413 MARCH 2011