SCRIP ORDER FORM
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New Requirement :Attach c opy of IRB Approval Letter and Compensation Section of the Consent Form
BUS 49 requires that staff handling scrip receive training on cash handling procedures.
Keep scrip in a locked receptacle or safe:
*Up to $1,000 in a lockable receptacle.
*From $1,001 to $2,500 in a safe.
*From $2,501 to $25,000 in a steel-door safe, with a door thickness of not less than
1 inch and a wall thickness of not less than .5 inch.
*From $25,001 to $250,000 in a class TL-15 composite safe or better.
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Scrip must be reconciled with Disbursements Scrip Coordinator quarterly
Reconciliation should include certification form, log sheets with scrip numbers and participants
signature or initials unless study is dependent on individuals remaining anonymous
Participants earning $600 or more in a calendar year are subject to tax regulations
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Scrip will be charged to the designated index at the time of issuance
Scrip becomes stale-dated one year from issuance and must be returned to Disbursements
Once issued to a participant, scrip needs to be cashed within 60 days
It is a violation of policy for UCSD employees to cash scrip on behalf of participants.
* UCOP link outlining Payments Subject to Tax: http://policy.ucop.edu/doc/3410214/AM-D371-12-1
Name of Trial:
Department
PI
Trial Dates
to
Departmental Scrip Coordinator
Email
Telephone
Date Requested
Index to be charged for Clinical Trial
Total Amount Requested
IRB #
Denomination
Quantity
Serial Numbers (Acctg Office Only)
$5
-
$10
-
$15
-
$20
-
$30
-
$40
-
$50
-
$75
-
$100
-
Other, write in
denomination:
-
Participants are within San Diego County
Yes
No
Approval Signatures
Departmental Scrip Coordinator
Index Authorization
Last Updated 07/16/2012