Research Corporation of the University of Hawaiʻi

Non-Employee Expense Payment Form
For Nonresident Aliens and Resident Aliens (by SPT), Print Out and Submit this Form Manually to RCUH Disbursing
Section A – Select one payee from Section A
Refer to Policy 2.008, Tax Treatment of Business Expenses (Service-Related)
Category (1)
Interviewee
Service Provider Volunteer (UH or RCUH)
Complete Sections B and C
Refer to Policy 2.006, Tax Treatment of Non-Service Financial Assistance (NSFA) for Individuals
Category (2)
Non-Qualified Scholarship/Fellowship Prize or Award
Research Study Participant
Complete only the payee’s name and the and C
boxes in Sections B
Section B – Enter Personal Information
Section C – Enter Expenses
Last Name, First Name
Document No.
Position Title
Employer
Project Contact & Phone
Address (Street, City, State, Zip)
FA Staff to Review
Itinerary
Airfare (attach original receipt)
Lodging (attach original receipt)
Meals & Incidental Expenses (city rate x # of days)
City
Rate
X Days
T otal
Dates of Service From (mm/dd/yy)
To (mm/dd/yy)
Other Expenses Description
Subtotal
Amount
Departure Date Time (mm/dd/yy)
Return Date Time (mm/dd/yy)
Document Number
Less Paid Requested
T otal
Payment Summary of Total Expenditures
Business Purpose (Category 1 Payees)
NSFA Details (Category 2 Payees)
Project #
Sub-Project
B/C
sub B/C
S/D
Amount

Category (1) payee claimant:
• The expense claimed may be excluded from income if it qualifies as a business expense and IRS Accountable Plan Rules are met. If these requirements are met, the payment is not income to the payee, and is not subject to tax reporting or withholding.
• If a payment does not qualify as a business expense, it is income to the payee, and may be subject to tax withholding and/or tax reporting.
• The expenses have not yet been, and will not again be, submitted to RCUH or any other organization for reimbursement or for tax purposes.
• My signature below: (a) certifies that the information stated on this form is true and correct, and that all expenses claimed in the “Total Requested” field above have been incurred with personal funds; and (b) indicates my acknowledgement and agreement to the above terms.
Lost Receipt Certification:
I certify that each individual expense under $75 listed above, for which no receipt or other proof of payment is available was used for the conduct of official business. The total amount of these expenses is .
NOTE: The above statement does not apply to:
• Lodging expenditures (an itemized receipt is required regardless of the amount). • Expenses $75 or greater (a receipt or other proof of payment is required).
Category (2) payee claimant:
• A non-service payment is income. Accountable Plan Rules do not apply to non-service expenses.
• Nonresident Aliens – All non-service payments may be subject to tax withholding and/or tax reporting.
• Resident Aliens (by SPT) – Non-qualified scholarship/fellowship travel is income, but is not subject to tax reporting. All other non-service
payments are income, but are only IRS reportable if the cumulative payments for a calendar year are $600 or more.
• U.S. Citizens and Permanent Resident Aliens – Non-qualified scholarship/fellowship travel is income, but is not subject to tax
reporting. All other non-service payments are income, but are only IRS reportable if the cumulative payments for a calendar year are
$600 or more.
• My signature below indicates my acknowledgement and agreement to the above terms.
Claimant Date
Principal Investigator Date Fiscal Administrator Date

Non-Employee Expense Payment Form Instructions
Purpose – For payment to an individual not employed by RCUH/UH. This form should not be used by UH students and UH post-doctoral fellows receiving scholarship or fellowship payments.
SECTION A. PAYEE CATEGORY
Category (1):
1. Interviewee
2. Service Provider
3. Volunteer (UH or RCUH)
Category (2):
1. Non-Qualified Scholarship/Fellowship 2. Prize or Award
3. Research Study Participant
SECTION B. PERSONAL INFORMATION
All fields are required for Category (1) payees. The following fields are required for Category (2) payees: 1. Name, 4. Project Contact & Phone, 5. Address, and 6. FA Staff to Review.
*1. Name – Last Name, First Name, and Middle Initial separated by commas. 2. Position Title – Job title with employing organization.
*3. Employer – Name of research institute/university/college or employer, if any.
*4. Project Contact–First and last name, and phone number of contact person regarding any inquiries.
5. Address – Street number and name, City and State, Country if not USA, & zip code or postal code.
*6. FA Staff –Name of Fiscal Administrator reviewing the form.
SECTION C. EXPENSES
All fields are required for Category (1) payees. The following fields are required for Category (2) payees: 4. Description of the Expense, and 12. Payment Summary of Total Expenditures (Project, B/C, and Amount).
1. Itinerary – List the departure and return city locations and all business destination cities.
2. Date(s) of Service – Provide the service period dates.
*3. Travel Dates – Specify travel period with dates and times of departure and return.
4. Description of the Expense – Enter Business Purpose Details (explain what services will be performed, for whom servicesare beingperformed,andthereasonitisbeingchargedtotheproject)ORtheNSFADetails(reasonforthe payment).
5. Airfare – Attach the original invoice or receipt that includes the claimant’s name, business itinerary (including dates of travel), and the total amount paid. The claimant must have paid for the expense.
6. Lodging – Attach the original invoice or receipt that includes the claimant’s name, dates of stay and the total amount paid.The claimantmusthavepaidfortheexpense.
7. Meals & Incidental Expenses (M&IE) – The city rate may not exceed the established Federal Allowable Rates. Attach the FederalAllowableRateschedulesforbusinesscities.
8. Other Expenses – Provide original receipts for all other expenses claimed.
9. Subtotal – Represents all expenses paid to or on behalf of the claimant. Include third-party vendor payments.
10. Less Paid – Subtract payments made previously, including vendor payments. Notate the document number (i.e., PO
number).
11. Total Requested – Total amount due to the claimant.
*12. Payment Summary of Total Expenditures (Project, B/C, and Amount).
TAXTREATMENT
For Category (1) payees
• The expense may be excluded from income if it has a business purpose and IRS Accountable Plan Rules are met If
these requirements are met, the payment is not income to the payee, and is not subject to tax reporting or
withholding.
• If a payment does not qualify as a business expense, it is income to the payee, and may be subject to: (1) tax
reporting for U.S. Citizens, Permanent Resident Aliens, and Resident Aliens (by SPT); and (2) tax withholding and/or reporting for Nonresident Aliens.
For Category (2) payees
• A non-service payment is income. Accountable plan rules do not apply to non-service expenses.
• Non-service payments may be subject to: (1) tax reporting for U.S. Citizens, Permanent Resident Aliens and Resident
Aliens (by SPT); and (2) tax withholding and/or reporting for Nonresident Aliens.