INFORMATION RESOURCES MANAGEMENT ADMINISTRATION
INFORMATION RESOURCES MANAGEMENT ADMINISTRATION
INFORMATION TECHNOLOGY SUPPORT DIVISION
Intra Agency Invoice
(Journal Entry Required)
DATE:_______________
This form authorizes the General Accounting Division to transfer funds from:
DIVISION:
CHARGE PCA CODE:
CHARGE OBJECT/ITEM:
AMOUNT: to the Budget Code shown below for the following items:
_____________________________________________________________________________________________
| | | |
|QUANTITY |ITEM |AMOUNT |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| |TOTAL | |
_____________________________________________________________________________________________
CHECK ONE:
XXXX CREDIT DHMH IRMA, Information Technology Support Division/-PCA Code B306G/
CREDIT the ______________________________________________________________________
BUDGET CODE __________________________________________________________________
FUNDS CERTIFIED AS AVAILABLE FOR TRANSFER TO THE ACCOUNT ABOVE BY:
_____________________________________________________________________________________________
SIGNATURE/TITLE DATE
__________________________________________________________________________________________
FUND TRANSFER TRANSACTION COMPLETED BY GENERAL ACCOUNTING DIVISION
_____________________________________________________________________________________________
SIGNATURE/TITLE DATE
NOTE TO UNIT BEING CHARGED: When transaction is completed, please return a signed copy of this form to Sharon Morazzani, IRMA-Policy, Planning & Administration Division, LL-4. (Rev.7/10/2000)
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