FIXED PRICE – RESIDUAL BALANCE CLOSEOUT FORM Complete and submit this form and all required attachments as one PDF document to your assigned ORS accountant. Please note that incomplete submissions will delay processing of the fixed price transfer. UH Principal Investigator: Email: Fiscal Administrator: Email: Department/Unit: Campus: Award Number: Termination Date: Project Account Number: Account Balance: Departmental Account to Receive Transfer: REQUEST CRITERIA 1. The scope of work is complete to the satisfaction of the sponsor. If the Account Balance indicated above is $3,000 or more, or more than 20% of the total award amount ("significant residual balance"), you must attach documentation from the sponsor that all work was satisfactorily completed 2. All allowable, allocable and reasonable costs necessary for the completion of the project, up to the total award amount, have been recorded in the project account. 3. All required payments have been received and recorded in the account by ORS. 4. The account is ready to be closed. If the project account has a significant residual balance, provide an explanation of why the funds were not expended. Personnel effort deviations must be explained in detail. Attach additional sheets if necessary. NOTE: Project salaries, wages and benefits should not be charged to department or general funded accounts. If the above justification includes costs charged to another project account, please attach a Declaration of Project Relatedness. By signing below, I certify that the award is a fixed price agreement, all four (4) criteria above have been met, and the explanation provided for any significant residual balance is accurate. Principal Investigator Signature: Date: Fiscal Administrator Signature: Date: If the project account has a significant residual balance: Dean/Director Signature: Date: ORS ACCOUNTING USE ONLY Residual Balance , less F&A on Residual Balance = Transfer Amount ORS Accountant Signature: Date: ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Approved Disapproved ORS Accounting Manager Signature: Date: Office of Research Services Rev. 04/19/2018

FIXED PRICE RESIDUAL BALANCE CLOSEOUT FORMApr 19, 2018 · NOTE: Project salaries, wages and benefits should not be charged to department or general funded accounts. If the above

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FIXEDPRICE–RESIDUALBALANCECLOSEOUTFORM

CompleteandsubmitthisformandallrequiredattachmentsasonePDFdocumenttoyourassignedORSaccountant.

Pleasenotethatincompletesubmissionswilldelayprocessingofthefixedpricetransfer.

UH Principal Investigator: Email:

Fiscal Administrator: Email:

Department/Unit: Campus:

Award Number: Termination Date:

Project Account Number: Account Balance:

Departmental Account to Receive Transfer:

REQUEST CRITERIA

1. The scope of work is complete to the satisfaction of the sponsor. If the Account Balance indicated above is $3,000 or more, or more than 20% of the total award amount ("significant

residual balance"), you must attach documentation from the sponsor that all work was satisfactorily completed

2. All allowable, allocable and reasonable costs necessary for the completion of the project, up to the total award amount, have been recorded in the project account.

3. All required payments have been received and recorded in the account by ORS.

4. The account is ready to be closed.

If the project account has a significant residual balance, provide an explanation of why the funds were not expended. Personnel effort deviations must be explained in detail. Attach additional sheets if necessary. NOTE: Project salaries, wages and benefits should not be charged to department or general funded accounts.

If the above justification includes costs charged to another project account, please attach a Declaration of Project Relatedness.

By signing below, I certify that the award is a fixed price agreement, all four (4) criteria above have been met, and the explanation provided for any significant residual balance is accurate.

Principal Investigator Signature: Date:

Fiscal Administrator Signature:

Date:

If the project account has a significant residual balance:

Dean/Director Signature: Date:

ORS ACCOUNTING USE ONLY

Residual Balance , less F&A on Residual Balance = Transfer Amount

ORS Accountant Signature: Date:

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Approved Disapproved

ORS Accounting Manager Signature: Date:

Office of Research Services

Rev. 04/19/2018

http://www.ors.hawaii.edu/files/TEAM_ASSIGNMENTS.pdf

http://www.ors.hawaii.edu/files/ProjectRelatedness.pdf