FRS State/Auxilliary Account Create/Modification Request Form

In order to create or modify a state supported or auxiliary account, please print this form, fill in the information below and forward the form to:

Budget & Fiscal Analysis

2132 Main Administration Bldg

For questions regarding state account creates or modifications, please contact BFA at x55627 or email BFA@umd.edu.

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Requestor (your name) ______________________________ Telephone ______________

I am requesting _______a new account or ________an account modification (check one). Please provide a separate form for each account.

Please provide a suggested new account number for account creates or the existing account number for modifications FRS #___________________.

For account modifications, please provide the detail for any changes including the old attribute information in the space below and have approver sign at the bottom.

For new accounts, please provide the following information in addition to the suggested account number above and the approver signature below:

Please give a brief explanation of the purpose of the new account:______________________________________________________________________________

_______________________________________________________________________________________________________________________________

Short Description (20 characters or less): ____________________

Long Description (40 characters or less): ____________________

____________________

Responsible Person (usually a Dean , Chair, Director, or VP): ____________________

Address of Responsible Person: _____________________________

Division Number (xx): _______

Department and Sub-department number (xxxxx-xx): _________________

Program (xx): ____________

(Instruction 01, Research 02, Public Service 03, Academic Support 04, Student Services 05, Institutional Support 06, Physical Plant 07, Auxilliary Enterprises 08) Note: Accounts for Academic Units are generally programs 01,02,03, or 04.

Support Indicator (x): ________

(1 State Support, 2 Self Support)

Signature of Approver (usually the Division or College Level Business/Budget Officer)

___________________________________ _________________

Signature Date

___________________________________

Print Name of Approver