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Instructions for completing the CSULB Petty Cash Disbursement Voucher form

About the Petty Cash Fund

When it is not practical to use the University procurement process, a University employee, after proper documentation and approval, may be reimbursed for business-related expenses incurred and paid by own funds.

Obtain verbal authorization to make cash purchases from the appropriate Administrator who will approve the Disbursement Voucher. The maximum amount that may be reimbursed from the Petty Cash fund is $50.00 (fifty dollars) plus sales tax. (reference: SAM Section 8112).

For tax reporting purposes the following expenses will not be reimbursed from Petty Cash Fund:

  • Meals, including overtime meals
  • Travel Expenses
  • Moving / Relocation Expenses

All expense items that are restricted or prohibited by the Procurement Card Policy will not be reimbursed from Petty Cash Fund.

Mileage and parking associated with local travel (destination less than 25 miles from the University) may be reimbursed from Petty Cash Fund without the need to submit a Travel Expense Claim (form 262). However, you must include your private vehicle license plate number and the mileage rate ($0.345) on the Petty Cash Voucher. Appropriate authorization approval is required.

Petty Cash funds should not be used as loans to the employee or any other person (i.e., no IOU's).

Steps for Petty Cash Reimbursement:

  1. Complete the Petty Cash Disbursement Voucher
  2. Obtain Administrative Services Manager / Division Fiscal Officer authorization prior to making your purchase.
  3. Make the purchase as authorized, and obtain either an invoice or receipt from the vendor (original cash register receipt is required).
  4. Bring the original, 'Petty Cash Disbursement Voucher' which has the signature approval of the Administrative Services Manager / Division Fiscal Officer, and original receipt attached to the Petty Cash custodian for reimbursement.
  5. The Campus I.D. of the purchaser is required before reimbursement can be made. If an employee is receiving the funds on behalf of the purchaser, a Campus I.D. for each employee are required before reimbursement can be made.

Note: Only the original 'Petty Cash Disbursement Voucher' and original receipt is needed to obtain reimbursement.

Step By Step Form Instructions

Department
Purchaser's Department
Division
Purchaser's Division
Location
Department Building and Room Number
Date
Provide current date
Name Of Vendor On Receipt
Indicate the name of the vendor where items are to be purchased. Note: Original receipts must be attached.
Description Of Items Purchased
Brief description of receipt for item / items purchased (e.g. stationary, hardware, software, books, etc.)
Sales Tax Charge On Receipt
List the Total Amount of Sales Tax Charged from each receipt
Total Amount Of Receipt
List Total amount (including Sales Tax) from each receipt to be reimbursed
Mileage Reimbursement Explain the purpose of the trip
Explain the need or reason for the travel (Example: Attend Year End Workshop)
License Plate Number of Vehicle Driven
Enter the license plate number of the privately owned vehicle used on official state business. To claim reimbursement, you must have met the requirements as outlined in CSU Policy and Procedures, HR 2001-02 pertaining to operator requirements, vehicle safety, seat belt usage, and authorization.
Total Miles Driven
Enter the number or roundtrip miles traveled using the privately owned vehicle listed
Total Travel Cost
Enter the total amount incurred for both mileage and parking. Mileage amount should be calculated as authorized by current agreements and regulations, as detailed in CSU Policy and Procedures, HR 2001-01. If only parking cost was incurred, then enter the amount of parking only. If mileage is the only expense, then enter the amount for mileage only.
Total Reimbursement
Combined total of all attached receipts
Purchaser's Name
Type or print the name of the person who made the purchase
Purchaser's Signature
Signature of purchaser
Date
Date purchaser signs Petty Cash Disbursement Voucher
Administrative Services Manager/Division Finance Officer
Signature of approving ASM or Div. Fin. Officer
Date
Date approving officer signs Petty Cash Disbursement Voucher
Chartfield Information
Complete this section with the appropriate ACCOUNT and FUND, and other applicable chartfields