Health Center Invoice (Vendor Payment Voucher) Form CO-17

• Policies
• Procedures
• Health Center Invoice (Vendor Payment Voucher) Instructions

Payments on Vendor Invoices may be made only to liquidate properly encumbered funds. Only Purchase Orders, Personal Service Agreements, and Travel Advances have encumbered funds.

All expenditures must have a business purpose. The business purpose should explain the benefit to the Health Center's program in terms that a lay person would readily understand. The business purpose for business meeting expenses must also include those individuals in attendance, as well as an agenda of topics discussed. Only actual costs incurred will be paid or reimbursed as documented by original invoices and/or receipts.

Expenses related to academic activities of the Health Center will be reviewed in the context of the following criteria:

• creating an environment to advance the exchange of ideas essential for the evolution of our academic curriculum, research and clinical care missions
• enhancing the Health Center's ability to recruit and retain the faculty necessary to achieve our academic goals

The business purpose for expenses related to academic activities should logically and obviously fit into one or both of the above two criteria.

A Health Center Invoice (Vendor Payment Voucher) Form CO-17 (PDF) must be prepared for claims against the Health Center for goods purchased or services rendered.

Examples:

• Personal Services rendered for a one time/one event service including all services and related expenses up to $2,999.99 in a calendar year, or services secured by Personal Service Agreements $3,000.00 and over.
• Payments made to, or on behalf of, guest speakers and lecturers under $3,000 in a calendar year.
• Candidate, Student, Non-State Employee travel expense reimbursements.
• Subscriptions and memberships under $10,000. (Subscriptions and memberships $10,000 and over must be paid on a Purchase Order).
  Note: For subscriptions, memberships and dues $10,000 and over, a "Purchase Requisition" must be used processed through the Purchasing Department.
• Fellowship stipends.
• Book purchases (library).
• Accreditation expenses.

Billings and Requests for Payment

On billings against Purchase Orders, the Accounts Payable staff will enter the Vendor Invoice against the appropriate Purchase Order.

On all other billings or requests for payment, the department involved will prepare the Health Center Invoice (Vendor Payment Voucher) Form CO-17 and submit it to the Accounts Payable Office (MC 4031) for processing.

For the invoice prepared by other departments:

• All supporting documents (i.e. Personal Service Contract, original vendor invoice and receipts, receiving report, copies of approved Travel Authorization Request for Candidate, Student or non-State Employee) must be attached to the Health Center Invoice (Vendor Payment Voucher) Form CO-17.
• Personal Service Agreement payments must first be sent to the Grants and Contracts office. Travel Authorization reimbursements are sent directly to General accounting.
• Authorized Signature - The Principal Investigator, Department Head, Dean, Director (or an authorized designee)must sign and approve the Health Center Invoice (Vendor Payment Voucher) Form CO-17 for payment.

[ back to top ]

To prepare the Health Center Invoice (Vendor Payment Voucher) Form CO-17 (PDF), follow the detailed instructions.

An Authorized Official must sign for approval of payment. The Principal Investigator, Department Head, Dean, Director (or authorized designee) must sign the form indicating approval for payment.

Send the original Health Center Invoice (Vendor Payment Voucher ) Form CO-17, with all supporting documents attached, to the Accounts Payable Office (MC 4031) for processing.

For invoices against Personal Service Agreements, forward the invoice to the Grants and Contracts Office (MC 5335) for approval.

Note: Checks requiring enclosures must have an additional copy of the enclosure.

The Accounts Payable Office will review and process the Invoice. Depending on the funding source, one of the following procedures will be followed:

• If the funding source are bond funds accounts payable will process the payment. Accounts Payable will send the payment directly to the State Controller's Office. Checks for invoices, which must be submitted to the State Comptroller's Office directly, will be mailed to vendors / payees in approximately two (2) to three (3) weeks from the date of receipt of the invoice in the Health Center's Accounts Payable Office.
• University of Connecticut Health Center checks will be generated for all other invoices. Health Center checks will be mailed directly to the vendors / payees, in accordance with the payment terms.

Invoices may be processed against either a Purchase Order or reservation funding. The reservation funding has been created for processing invoices where Purchase Orders are not necessary.

[ back to top ]

Health Center Invoice for Goods or Services

Vendor Payment Voucher (Vendor Invoice) Form CO-17

Please fill in the following information on a blank Health Center Invoice.

(A) DOCUMENT DATE
Date that this CO-17 is prepared (MM/DD/YY).

(B) ACCOUNTS PAYABLE BATCH NUMBER
Leave blank.

(C) DOCUMENT NO.
Each Department should keep a listing of their own unique seven (7) digit numbers. Care should be taken to ensure that each form has a different consecutive number.

(D) RECEIPT DATE
Date Goods and/or Services are received, or, in certain instances the date payment is contractually due (MM/DD/YY).

Examples:

• Commodities, Supplies and Equipment - The date which goods were received by the department.
• Debt Services - The date that the payment is due to the fiscal agent.
• Equipment Leases - The ending date of the rental period for the invoice being processed.
• Insurance - The payment due date of the premium invoice.
• Outside Professional/Nonprofessional Services - The ending date of the billing period.
• Printing and Binding - The date that the printed material is received.
• Prizes, Awards, Loans Prizes, Awards, Loans - The date that the prize, award or loan is officially an obligation of the state.
• Real Property Rent - The payment due date.
• Repairs - The date repairs were completed. For progress (partial) payment, the latest date covered by the billing.
• State Aid and Other Grants - For grants payments which have a statutory or contractual due date, enter the due date as the receipt date.
• Subscriptions - The date of the invoice.
• Travel - The ending date of the travel period.
• Utility Services - The ending date of the billing cycle.
  
  

(E) P.O./P.S.A. NO.
Reference original Commitment Document for Commitment Number, if any., e.g. PURCHASE ORDER NUMBER or PERSONAL SERVICE Agreement NUMBER.

(F) RPT. TYPE
Reportable Type. Indicate if the payment should be reported as miscellaneous income on IRS Form 1099. (Y - yes, N - no, T - town payment).

(G) VENDOR FEIN/ SSN
List Federal Employer Identification Number or Social Security Number. If multiple listing (Form CO-17L) is being used, do not complete this block.

(H) DOCUMENT AMOUNT
The subscription, memberships and dues amount to be paid. The Document Amount must be equal to the Expended Amount in Block K.

(I) VENDOR / PAYEE - The Vendor's full Name and Address. If there are multiple payees, an Invoice Listing, Form CO-17L, must be attached to the Vendor Payment Voucher (CO-17), and in the VENDOR / PAYEE block type the statement: "See attached Multiple Listing, Form CO-17L."

(J) VENDOR BILLING INFORMATION
Vendor Invoice Number, Grant Payment Code, or other vendor information. This identification will be printed on the check which enables the vendor to identify the payment.

(K) DESCRIPTION
Description of Goods and/or Services completed, or the itemized travel expenses. INCLUDE BUSINESS PURPOSE FOR THIS EXPENSE.

(L) AMOUNT
Number of Units times the Purchase Price for each item.

(M) CHECK DUE DATE
Date check must be written.

(N) ENCLOSE ATTACHED DOCUMENTS WITH CHECK
[ ] YES [ ] NO

Note: Any documents that are to be enclosed with the check must be duplicated, two (2) copies must be sent along with the invoice for payment. Please staple to the Invoice to avoid loss of original documents.

(O) ENCLOSURE CODE

• "D" - Document to be mailed to vendor with check
• "G" - Check to be picked up at Bursar's Office by Department

(P) CHECK TO BE PICKED UP AT BURSAR'S OFFICE
[ ] YES [ ] NO

(Q) PERSON TO CALL
Name and Phone Number of Person to call when check is ready.

(R) JUSTIFICATION FOR PICK UP
Checks are not routinely returned to the department for mailing. Therefore, there must be valid justification for a representative of the department to pick up the check rather than having it mailed out directly to the vendor. The individual picking up the check must have proper personal identification.

(S) LEDGER NUMBER
A one (1) digit number.

(T) ACCOUNT NUMBER
A five (5) digit number.

(U) SUBCODE NUMBER
A four (4) digit number.

(V) AMOUNT
The total amount to be paid. The amount must be the same as Document Amount.

(W) DEPARTMENT and MAIL CODE
Name and Mail Code of the department submitting the form.

(X) PREPARED BY and PHONE
The name of the person who prepared the form and the telephone number of that person, where specific questions regarding the contents of the form can be answered.

(Y) AUTHORIZED SIGNATURE/ APPROVAL
Signature of the Principal Investigator, Department Head, Dean, Director (or authorized designee) indicating approval for payment. An individual listed as Vendor/Payee may not approve his/her own invoice.

[ back to top ]