Explain why it is important to your study that the participant be paid in cash instead of a university check:

Name and Topic of Study:

IRB Number & IRB Contact Name:

Estimated schedule of payments per month, for three months:

Maximum TOTAL amount a subject will receive:

Date that subject payments will start and end:

Accountability Plan for cash (Control/Distribution)  see link – BPPM section under Finance 2:250 (Research Participation)

Describe how payments will be documented: (note that Date, Name, SS #, Permanent mailing address, amount, and signature are required)

Chartfield String that expenses will be charged to:

Preparer's name and phone number: