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
 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
.
See the Comments field
on page three to enter:
 Information about a
terminated employee
 Change information for
a previous NE
 Additional address
information
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):rsnell@ssc.wisc.edu
Department Name:Institute for Research on Poverty
Campus Address:1180 Observatory Drive
Alternate’s: Default Dept ID484260
Fund133
Division Contact Information
Name:Michelle Massen
Telephone:262-6358
Program4
Project
E-mail:massen@ls.admin.wisc.edu
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):cwilliam@ssc.wisc.edu
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:massen@ls.admin.wisc.edu
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):wambach@ssc.wisc.edu
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:massen@ls.admin.wisc.edu
Last updated: 3/10/2016
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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):dchancel@ssc.wisc.edu
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:massen@ls.admin.wisc.edu
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.
Visa
Type
H1B
Division and/or Department verifies that it has:
B-1/B-2
Obtained and, will retain at the department, copies of the supporting
documents that are check marked.
WB/
Waiver
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).
F-1
Last updated: 3/10/2016
J-1
Documents
Required
Passport
I-94
Passport
I-94
Passport
I-94W
Passport
I-94
I-20
Passport
I-94
DS-2019
Page 2 of 3
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:
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.
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: 3/10/2016
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