Non-employee Profile Set-up Request for e-Reimbursement
Accounting Services, 21 N. Park Street, Suite 5301, Madison, WI 53715-1218
Please e-mail the completed form to the Dean’s/Divisional office.
Use this form only for non tax-reportable reimbursement. Use the Payment to Individual (PIR) form for tax-reportable expenditures (e.g., honorariums, fees for service, etc.).
Select one of the options:
· New Non-employee for individuals who do not have
a profile set up in the e-Reimbursement system.
· Alternate for Terminated Employee when an employee’s appointment has ended; provide the terminated UW Person ID: .
· Change Information if the individual already has a Non-employee
ID number; provide the previous Non-employee ID: NE .
Department Information
UW-Madison Alternate (Preparer) for Non-employee
Last Name (30 characters max):Snell
First Name (30 characters max):Robin
UW Person ID:254247 Position Title:Financial Specialist 2
(Find the UW Person ID on the earnings statement; see the Work Record tab in My UW. Do not use SS#.)
E-mail (required): Telephone:262-6358
Department Name:Institute for Research on Poverty
Campus Address:1180 Observatory Drive
Alternate’s: Default Dept ID484260 Fund133 Program4 Project
Division Contact Information
Name:Michelle Massen E-mail:
1. Other UW-Madison Alternate (Preparer) for Non-employee (Fill in only if applicable.)
Last Name (30 characters max):Williams
First Name (30 characters max):Coreen
UW Person ID:298282 Position Title:Program Assistant Supervisor Advanced
(Find the UW Person ID on the earnings statement; see the Work Record tab in My UW. Do not use SS#.)
E-mail (required): Telephone:262-6175
Fill in Department, address, and Division contact information if different than above.
Department Name:Institute for Research on Poverty
Campus Address:1180 Observatory Drive
Alternate’s: Default Default Dept ID484260 Fund101 Program4 Project
Division Contact Information
Name:Michelle Massen E-mail:
2. Other UW-Madison Alternate (Preparer) for Non-employee (Fill in only if applicable.)
Last Name (30 characters max):Wambach
First Name (30 characters max):William
UW Person ID:28362 Position Title:Assistant Director
(Find the UW Person ID on the earnings statement; see the Work Record tab in My UW. Do not use SS#.)
E-mail (required): Telephone:262-6179
Fill in Department, address, and Division contact information if different than above.
Department Name:Institute for Research on Poverty
Campus Address:1180 Observatory Drive
Alternate’s: Default Dept ID484260 Fund101 Program4 Project
Division Contact Information
Name:Michelle Massen E-mail:
3. Other UW-Madison Alternate (Preparer) for Non-employee (Fill in only if applicable.)
Last Name (30 characters max):Chancellor
First Name (30 characters max):David
UW Person ID:419586 Position Title:Director's Assistant
(Find the UW Person ID on the earnings statement; see the Work Record tab in My UW. Do not use SS#.)
E-mail (required): Telephone:890-1317
Fill in Department, address, and Division contact information if different than above.
Department Name:Institute for Research on Poverty
Campus Address:1180 Observatory Drive
Alternate’s: Default Dept ID484260 Fund144 Program4 Project
Division Contact Information
Name:Michelle Massen E-mail:
Non-employee Information
Forms with missing or incomplete information will be returned.
Has the individual ever been a UW-Madison employee (Yes/No)? If yes, the Department verifies that individual is an inactive UW-Madison employee (Yes/No)?
If yes, indicate inactive date:
All non-employee address information is required. All payments to non-employees will be made by check. Use only a full, legal name. Nicknames or aliases are not allowed.
Last Name (30 characters max):
First Name (30 characters max): Middle Initial:
Address Line 1:
Address Line 2 (Indicate if N/A):
City: Zip or Postal Code:
State and/or Providence: Country:
Non-employee: Default Dept ID Fund Program Project
Date of First Travel Expense (enter additional information in Comments section):
Is the non-employee a U.S. Resident (Yes/No)?
If U.S. Resident, please supply the U.S. Taxpayer Identification Number (SSN last four digits of the Social Security number, ITIN, or EIN).
Required Information for Profiles of Foreign Visitors
Notes:1. Do not send copies of documents to Accounting Services.
2. FOR CANADIANS ONLY: Use a second form of picture ID in lieu of the I-94 when the visitor does not obtain an I-94.
Division and/or Department verifies that it has:
Obtained and, will retain at the department, copies of the supporting documents that are check marked.
Reviewed all of the original documents listed on this form for the Visa Type of the Non-Resident Alien (NRA) and obtained legible copies of these documents; passport picture must be legible to identify the NRA. Documents were reviewed for correctness, accuracy, and expiration dates per UW and Federal (e.g., Homeland Security and IRS) requirements. See an outline of the requirements at http://www.bussvc.wisc.edu/howto/acct/requiredtx.html (linked below under Resouces). / Visa Type / Documents Required
H1B / Passport
I-94
B-1/B-2 / Passport
I-94
WB/
Waiver / Passport
I-94W
F-1 / Passport
I-94
I-20
J-1 / Passport
I-94
DS-2019
Use the space below to enter additional address information, any non-employee change information, or information about a terminated employee (see memo, Impact of Faculty and Staff Appointment End Dates on the e-Reimbursement System, linked below under Resources).
Comments:
Last updated: 12/08/10 Page 1 of 3
Instructions for Submitting the Form
1. Save the form and attach to e-mail.
2. E-mail the form to your Dean’s/Divisional office.
Last updated: 12/08/10 Page 1 of 3
Resources
▫ Non-employee Profile Set-up Form processing instructions: http://www.bussvc.wisc.edu/acct/policy/nonemployee/reimburpro.html
▫ Payment to Individual (PIR) instructions: http://www.bussvc.wisc.edu/acct/policy/pir/pirpol.html#PIRinstructions
▫ Log into MyUW: https://login.wisc.edu/?appurl=my.wisc.edu/portal
▫ How To Determine Which Tax Related Documents are Required When Making Non-Payroll Payments at UW-Madison:http://www.bussvc.wisc.edu/howto/acct/requiredtx.html
▫ Impact of Faculty and Staff Appointment End Dates on the e-Reimbursement System: http://www.bussvc.wisc.edu/acct/TEWeb/memos/apptenddates15apr2010MEMO.pdf
Last updated: 12/08/10 Page 1 of 3