Edit ClinCard Account

Edit ClinCard Account

Complete this form to request additional ClinCard funds or edits to your ClinCard Account.

Key policies and resources for this form:

ClinCard Policy
Research Participant Policy
View your current ClinCard account(s)
List of Chief Business Officers by unit
List of Account Codes
View status of ClinCard account(s)
Submit a new ClinCard application

Name*

Please enter your name here.

Email Address*

Please enter your UGA email address here. Please use your MyID email rather than your alias email. This will allow you to view your entries later from this webpage.

Phone Number

Please enter your Phone number here.

Phone

I would like to*

Add ClinCard Funds

Request a deadline extension

Transfer the Approver

Transfer the Custodian

Transfer the Study Coordinator

Update ClinCard Chartstring

Please enter the original application ID for the account that you'd like to edit.*

To find your Application ID, go to this webpage and select your role in the "View ClinCard Account Status" section.

Justification

Please briefly describe the reason for this change and any additional comments that should be considered with this change.*

Current Study Coordinator

Current Study Coordinator Name*

Current Study Coordinator Email*

This email will be used for approval routing, so please enter this information carefully.

New Study Coordinator

Study Coordinators will have access to their designated studies. They will be responsible for registering human subjects into the ClinCard system, assigning ClinCards, and submitting compensation to the subjects. Prior to registering a human subject, the Study Coordinator should ask the human subjects whether they have current ClinCards from a prior study. If a human subject has a current ClinCard, the Study Coordinator should contact the Bursar’s Office to add the human subject to this study.

Important: The Study Coordinator and Approver must be different individuals, Approver must be full-time employee of the University of Georgia, and must satisfy all requirements of the ClinCard Policy. A study coordinator cannot be an approver of any other petty cash account, nor can an approver be a study coordinator of any other petty cash account.

New Study Coordinator Name*

New Study Coordinator Email*

This email will be used for approval routing, so please enter this information carefully.

Current Custodian

Current Custodian Name*

Current Custodian Email*

This email will be used for approval routing, so please enter this information carefully.

New Custodian

New Custodian Name

New Custodian Email

This email will be used for approval routing, so please enter this information carefully.

Current Approver

Current Approver Name*

Current Approver Email*

This email will be used for approval routing, so please enter this information carefully.

New Approver

Approvers may be designated at the study level to approve compensation. The Study Coordinator scheduling compensation cannot be the same person who approves the compensation.

New Approver Name*

New Approver Email*

This email will be used for approval routing, so please enter this information carefully.

Additional Approvals

Approval request emails will be sent to the individuals below along with the unit's CBO or Dean/VP. This email will be used for approval routing, so please enter this information carefully.

Dept. Head or Director Email*

Department Information

School, College or Unit*

Select

Department Name*

Account Details

Study/Program Name*

Please enter the name of the study or program name for your ClinCard account.

Total amount originally funded on Current ClinCard Account*

Please enter the total dollar amount that was originally funded on your current ClinCard account.

Request Increase

Total Amount of New ClinCard Account*

Please enter the new total amount of the ClinCard account you are requesting (not the amount of the increase).

Number of New ClinCards requested*

Please enter the total quantity of new ClinCards requested.

Type of ClinCards

Please indicate which type(s) of ClinCards you are requesting.

Physical Card

Virtual Card

Physical AND Virtual Card

Location

Building where these cards will be stored:*

Room # where these cards will be stored:*

Phone # for the storage location:*

Phone

Request to extend deadline

Current Deadline

Requested New Deadline

Use of Funds

Will any of these funds be used for paying foreign nationals?

Check this box if these funds will be used to pay foreign nationals.

Are the participants going to be in the United States when the ClinCards are issued?”*

Yes

No

Will the ClinCards be used on a sponsored project?*

Yes

No

Please enter the Project ID (e.g., RNIHX00000001)*

This will be used to check available funds in this section of the project budget.

Chartstring

Please enter the chartstring for this ClinCard account. Several of the fields below are dropdown menus. If the value you need to enter is not listed on the dropdown menu, please type it in instead.

New Chartstring

Please enter the new chartstring for this ClinCard account. Several of the fields below are dropdown menus. If the value you need to enter is not listed on the dropdown menu, please type it in instead.

Account Code*

Note that there is only one account code available for selection on ClinCards at this time.

Select or enter value

Fund*

Select or enter value

Program*

Select or enter value

Department*

Select or enter value

Class*

Select or enter value

Activity*

Operating Unit (optional)

Select or enter value

Chartfield 1 (optional)

Select or enter value

If additional documentation is needed to support your request, please upload below.

Drag and drop files here or

Send me a copy of my responses

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