Instructions: Reconciliation is due within 30 days after the use of funds end date. Complete all required fields. Include any required documentation with this form. For information on process and requirements, contact the AVP Research Office at 245-2314.

1. P.I.

2. SAP Vendor No.

3. Advance Type

One Time or Human Subjects

Revolving

4. Project

5. Use of Funds End Date (from Advance form)

6. Funds Commitment

7. Human Subjects Reconciliation (GL 767903)

Number

Award Amount

Total

8. Research Expense Reconciliation

Participant Level A

$ -

Total Itemized Expenses from Form AP-6 Supplement (Attach)

Participant Level B

$ -

Total of Prior Reconciliations for Revolving Advances

Participant Level C

$ -

Total Expenses To Date

C. (A+B)

$ -

Other

Less Total Amount Advanced

$ -

Total Human Subject Expenses

$ -

Balance/Pending Balance

E. (C-D)

$ -

Less Advance Requested

$ -

Balance (Positive - Reimbursement to PI; Negative - Deposit Needed)

C. (A-B)

$ -

If negative, indicate that a copy of Deposit Receipt is attached: Deposit Info: GL 101120 Fund 2025031000

9. Funding Source(s)

GL Code

Cost Center

Fund

Internal Order

Amount

Note: The total expenses in Section 9 for human subjects and/or research expenses must equal the total in item 7A or 8A.

Total

$ -

Under penalty of perjury, I, the undersigned recipient, certify that the expenditures for which I am reporting were expended within the guidelines of the specified funds, for official Texas State business purposes, and in compliance with UPPS No. 02.02.06 and Circular A-21.

10. Approvals

Signature

Printed Name

Date

Signature

Date

Requesting Investigator