Cash Advance Request Form

Cash Advance Request Form

Requestor Name*

The requester is the person to whom the cash advance will be issued. The requestor must have a PAID appointment at UT for the duration of the cash advance.

Requestor EID*

Requestor Email Address*

Account Number*

Please provide 10 digit account number (e.g.,12-3456-7890)

Faculty Name

If requestor is not the faculty member in charge of the account

Study Title*

Full title as it appears on the IRB

IRB Number*

Approved IRB number (e.g., 2017-01-1234)

How will the study be conducted?*

Select or enter value

Payment Method*

Describe the participant payment method (cash, gift cards, mailed check, etc.)

Total Amount Requested*

Minimum $100

Description of Inventive Payments*

Ex. 51 participants @ $50 for behavioral visit: $2,550

Disbursement Method*

If you choose direct deposit, make sure you have set up non-payroll direct deposit in My Bank Information

Select or enter value

Date Check/Direct Deposit Requested*

Must be at least 10 business days from date request is submitted

Cash Advance Start Date*

You can request up to a month before the above check/direct deposit date if you have to compensate participants now, out-of-pocket, and can reimburse yourself once you receive the cash advance

Cash Advance End Date*

Six month maximum from the above start date. Cannot be after the current end date of the study IRB approval or after requester's appointment time.

Additional Notes

Comments or special requests. If you already have a cash advance out for the same study, please indicate when you will submit the reconciliation.

Please refer to HBP 9.1.7. Advances for Research Subjects and Survey Participants to learn more about cash advance procedures.

Send me a copy of my responses

Privacy Notice|Report Abuse