Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
COMPLIANCE STATEMENT FOR PAYMENTS TO VISITORS AS566
IN BUSINESS OR TOURIST STATUS
VISITOR’S INFORMATION
_______________________________ _______________________ _________
Last Name First Name MI
Current Visa Status __________
Please check one:
U.S. SSN _______________________ ITIN __________________________
Dates of Activity for which Visitor is being paid __________________________________________________
Brief Description of Activity
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
I attest that I have been engaged in activities described above for the benefit of Louisiana State University for nine
days or less. I further attest that I have not been paid or reimbursed by more than five other U.S institutions or
organizations during the past six months.
____________________________________ ______________________________ ______________________
Visitor’s Signature Printed Name Date
As sponsor of the above individual, I attest that the individual has been engaged in the activities described above for
the benefit of Louisiana State University for nine days or less. I attest that the activities for which the individual is being
paid or reimbursed are within the broad realm of customary academic activities associated with teaching, research,
public service, academic administration or academic operations.
____________________________________ ______________________________ ______________________
Department Head Printed Name Date
Rev 07/16
