PARTI (To Be Completed by SUNY Fredonia Sponsoring Department)

SUNY FREDONIA

HONORARIUM REQUEST FORM

PARTI (To be completed by SUNY Fredonia Sponsoring Department)

Payee Name: ______
First MI Last Social Security Number

Home

Telephone: ______

Home ______

Address: Street Apt. #/Box #

______
City State Zip Code
Reason for Honorarium:
(Speech, Performance, Workshop,Assessment, etc.)
Date(s) Services Performed
From: ___/____/____ To: ____/___/____
Payee’s Current Employer: ______
Business Address: ______
______
Authorized By:
Name: ______Amount Due: ______
Title: ______Account Number: ______. ______
Department: ______Authorized Signature: ______

PART II (To be completed by Payee)

Payee Certification

I certify that the above bill is just, true, and correct; that no part has been paid except as stated and that the balance is actually due and owing, and that taxes from which the State is exempt are excluded.
______
Payee’s Signature Date(must not be prior to end of service)

PART III (To be completed by Human Resources)

Human Resources
I certify that recipient was not on a State Payroll at the time of this service.
______
Authorized Signature Date(must not be prior to end of service)

PART IV (To be completed by Accounting)

Accounting Office Use Only

UNSPSC Code: ______Object: ______Commodity:______
Liability Date: ______MIR Date: ______
Interest Eligible: ______1099: ______Reviewed By: ______

See Reverse Side for Instructions and Information on Honorarium

Revised 2/10

HONORARIUM

An honorarium is a one-time payment for services rendered by an individual to SUNY Fredonia. It may include a payment for speaking or performing, conducting a workshop, etc. Any travel reimbursement due the Payee must be obtained through the completion of a travel authorization and travel voucher.

If the sponsoring department discovers the payee is currently a State employee, they must contact Human Resource (HR) for additional instructions.

Honorarium Payment Process

Step 1 – The sponsoring SUNY Fredonia department completes Part I of Honorarium Request Form and obtains the authorized signature for the account to be charged. Upon completion of service, the sponsoring department presents the form to the Payee forcompletion of Part II.

Note: Contact the Accounting Office at ext. 3467 four weeks in advance of the service if the payment for service exceeds $2,500 per day or the Payee requires payment on the day of service.

Step 2 –Payee completes Part II upon completion of their service and returns the form to sponsoring department. The sponsoring department forwards the form to Human Resources (HR).

Step 3 – HR reviews the form to verify the Payee was not employed by New YorkState at the time of service. Upon review, HR forwards audited form to Accounting for processing.

Step 4 – Accounting reviews and authorizes payment. Accounting inputs payment for services rendered to the Payee.