2017-2018 Program and Budget Handbook
ATTACHMENT H (revised 7/28/16)
Los Angeles Unified School District Federal and State Education Programs TITLE I IMPREST FUND CLAIM FORM
Vendor Account No. :
Vendor Name: Prepared by:
Fund Functional Area Cost Center No.
To access this form go to achieve.lausd.net/fsep , then click on Publications
I certify that 1) the above statement is correct and that all materials listed thereon have been received; 2) there is no profit of any kind for me in this claim and that is in accordance with Section 60071 of California Education Code; and 3) charges to donation are within the donor's stipulated allowable use.
Signature of Administrator
Print Name of Administrator
Title I Allowable GL Accounts (Commitment Items)
430010 Instr Material-General Purpose 520002 Travel/Conference Attendance
580005 Admission Fees 580012 Contract Bus Services
Ensure all required supporting documents are attached to email, e.g. SPSA or SPSA Modification, itemized receipt/invoice for the purchase and/or approved 10.12.1 travel form or approved 34-EH-57 field trip form. Email completed claim form to firstname.lastname@example.org with following subject line on your email " Imprest - School/Office - Claim Number (current fiscal year- cost center-claim count-FG) ". FSEP will not accept faxes. The lack of adherence to these procedures may delay the timely processing of the Federal Grant (Title1) Imprest Fund Claim. Appendix D-3
Form no. IMP-1706FG
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