Rev 07/16
Louisiana State University
Office of Accounting Services
Financial Accounting & Reporting
204 Thomas Boyd Hall
REQUEST FOR AGENCY/CLEARING AS502
Add Update Delete
Purpose of _________________________________________________________________________________
Source of Funding ___________________________________________________________________________
Function ___________________________________________________________
Fringe Benefits Fringe Benefit Rate ___________________
Suggested Name of __________________________________________________________________________
Requested Term of _________________________ through _________________________
Contact (Responsible for administering funds) _____________________________________________________
Contact Email ___________________________________________ Phone _____________________________
Relationship of Contact to Organization __________________________________________________________
Instructions for disposition of funds remaining at termination date ______________________________________
__________________________________________________________________________________________
Approved by:
__________________________________ _________________________________ ___________________
Dean/Unit Director Printed Name Date
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FOR ACCOUNTING SERVICES USE ONLY
Agency/Clearing Name ____________________________________________
Agency/Clearing ID AG __ __ __ __
Processed by __________________________________________ Date _______________________
Company
Cost Center Hierarchy
Cost Center
Cost Center ID
Organization Name
Address of Organization
Organization Federal Tax ID #
(if applicable)
Print Form
Rev 07/16
AS502, “REQUEST FOR AGENCY/CLEARING WORKTAG
INFORMATION SHEET
Purpose
The agency/clearing is maintained for organizations which make use of University services but are not sponsored
by, or closely associated with, the University mission. True agency accounts are limited in number since they
stand alone as entities separate from the University. These accounts are for groups or organizations which hold
activities on the campus, or have an officer who is an employee of the University who is authorized to acquire
goods or services through the University on behalf of the organization.
Revenue Sources
In order to keep the integrity of the organization separate from the University, no revenues can come from
University funds. All sources of revenue are from membership fees, registrations, dues, donations, or earnings of
the organization.
Expenditures
The accounting system can be used for internal transactions for catering, housing, meeting room rental, supplies,
and the like. The purchasing system can be used for off-campus vendor payments as well.
Setup
The representative of the group/organization submits form # AS502 to Accounting Services. The organization
name, taxpayer ID number, purpose of account, and source(s) of funding should be provided. If representatives
are elected periodically, outgoing officers should notify our office in writing, providing a sample of the authorizing
signature of the incoming officer. Specific guidelines for the disposition of any excess funds at the conclusion of
the group activity should be provided (ie: submission to national office, or forwarding to a future host campus).
Personal Services
There should be no payments for salaries or wages on agency accounts since the University is not responsible for
reporting W-2 or 1099 income on agency funds. Individual organizations have their own reporting liability, and
LSU can not accept responsibility for payroll functions on behalf of an outside group