ࡱ> 463{ bjbjzz :$ JJJJJ^^^8$^(;======$b0aJaJJvpJJ;;HAR'0DtDDJ aaD :  Please complete a separate questionnaire and proposal for each service center or recharge activity. This questionnaire should be submitted to the regional campus chief financial officer with each request to establish a Recharge Center or Time & Materials Center. In addition, an updated copy of the questionnaire should be submitted to the chief financial officer, or designee, with each annual rate proposal. (See accounting manual procedure P-112 for guidelines on service/recharge centers and allowable costs) Name of service center: Service center org/fund number(s): Individual to contact: Work phone number: Date questionnaire was completed: Period for which rate is requested: Estimated recoverable costs for the period: Estimated revenue for the period: Estimated amount charged to federal grants and contracts: Rates proposed: I reviewed this questionnaire and proposal. I believe it fairly represents the activities of the respective service center and request authorization to implement these rates as proposed. Dean/Director certification CFO (Chief Financial Officer) Approval: 1. Provide a brief description of the recharge activity, including why it is needed, principal customers or beneficiaries, and anticipated activity levels (attach explanation). 2. Provide a brief description of the service center's operating cycle or other period over which accumulated revenues are expected to be approximately equal to accumulated allowable costs including equipment use allowances (attach explanation). 3. Provide a brief description of the methodology used to establish the recharge rate, markup, or price (attach explanation). 4. What unit of measure is used as a billing base (hour, day, procedure, mileage, etc.) 5. Approximately how many units will be processed or sold during the fiscal year? 6. Are all users charged for this service? Yes No If no, how do you determine who is charged? 7. Are charges made to anyone other than university departments and grants and contracts? Yes No If yes, who are these external customers and estimated amounts of annual activity? 8. Are all users charged the same rate? Yes No If no, how do you determine which rate is used? 9. Are any costs related to this activity charged to another account or is the activity subsidized in some manner? Yes No a. If yes, please describe the nature of the subsidy. b. Approximate amount of subsidy for the fiscal year. $ 10. Is an inventory required for this activity? Yes No If yes, what is the average value of the inventory, at cost? 11. Are there any significant assets (cash, accounts receivable, land, etc.) liabilities, commitments, or risk management exposures associated with this activity? Yes No If yes, please describe? 12. Attached proforma income statements, schedules, and other supporting documentation and explanations as described in the accounting manual procedures for service/recharge centers, P-112.     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