Attachment I

 

Texas State University

Personal Cellular Services Allowance Form

 

This form authorizes an employee an allowance for reimbursement up to $600.00 USD for university use of their personal cell phone plan. Note: This allowance is intended to assist with the cost for usage of cellular service, and not necessarily to cover the total costs.

 

In order to obtain an allowance for an employee:

 

 

 

 

Printed Name

Texas State PLID

 

 

 

 

Department

Work Phone/Cell Phone

 

 

 

 

Account Manager

Allowance Amount

 

Please select appropriate level to determine the monthly allowance from the schedule below.

 

Level

Plan Level I

Plan Level II

Plan Level III

Amount

$20.00

$35.00

50.00

(Note: explanation of each service plan level is found on the second page of this form)

 

 

I have read UPPS No. 05.03.11, Texas State Wireless Cellular Communication Services, and understand

 

  1. The associated employee responsibilities.
  2. That these allowances are considered taxable compensation subject to required tax withholdings; and
  3. These allowances are NOT part of my base salary.

 

 

 

                                                                                                                                               

Employee’s signature                                                                     Date

 

 

 

                                                                                                                                               

Authorizing Signature                                                                    Date

Division Vice President

College Dean

Athletics Director

                                   

                                                                                                           

Legend:

 

Service Plan Level

Description – Usage is defined as voice, data, features, etc. regardless of instrument type.

I

Minimal amount of business usage anticipated

II

Moderate amount of business usage anticipated

III

Power user, much of anticipated usage is business-related