School of Computer Science Form Revision 4.1.2011
Amazon Mechanical T urk P rocurement S upplemental Cover Sheet
Type of Request New Date
Incremental (attach previous requests)
Prepared By Principal Investigator
Amount Requested with this TPS Cover Sheet IRB Number
(if applicable)
Estimated Total (if known and different from above)
If total exceeds $1,000, request a formal exception via the ALG representative and the Pcard Office; attach approval to this form.
Details of This Request
1 Please describe the requested study, its research purpose, the volume of expected/hoped for number of
responses/participants, and the length of time the requested study will be open.
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2 Please note the string to be charged. Insert charge string here.
3 Will personally identifiable information (PII) be collected during or after the completion of this study?
If so, describe how this data will be safeguarded.
Insert text here.
4 If no IRB number was provided above, please explain why IRB approval is not necessary.
Insert text here.
5 Is there any risk that CMU or faculty IP will be exposed through this study? If this exposure is of no concern, explain why.
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6 How will the requested study be paid for:
Pcard Expense Reimbursement
* Studies paid for out-of-pocket by the researcher will not be reimbursed until the
study is completed, in full.
Submission Checklist The following items should be included with any and all ER/PRC reconciliations related to this request.
This form.
ALG/Pcard Office approval (if applicable).
Bid Checklist with sole source justification (if total is expected to exeed $2499).
A copy of the current AMT Participation Agreement.
Any and all receipts from the AMT system regardless of dollar amount (see note, below).
Approvals
Preparer Date DDFR Date
Note on funding and receipt requirements:
The initial AMT transaction setting up the REQUESTED STUDY will result in an online receipt. This receipt should be used when verifying PCard transactions. In addition, if the duration of
the REQUESTED STUDY is less than 30 days, it should be possible to also include the AMT transaction record for the REQUESTED STUDY, which is evidence that 100% of the initial funding
for the REQUESTED STUDY have been used. If the duration of the REQUESTED STUDY is longer than 30 days, then the PCard transaction should be verified using the initial receipt and as
much of the REQUESTED STUDY transaction record as is available, and submit the receipt packet as usual. When the REQUESTED STUDY is completed, that receipt packet should be
replaced with a copy that includes the whole transaction record for the REQUESTED STUDY. Expense reports should be submitted only after the REQUESTED STUDY has been completed
and should include the initial payment receipt and the whole transaction record.
It is permissible to fund only a portion of the total expected volume of a REQUESTED STUDY in order to avoid residual balances on a REQUESTED STUDY. In order to protect against the
appearance of splitting transaction on a PCard, the cardholder should identify the possibility of additional funding on the same REQUESTED STUDY at the time of requesting approval
from the DDFR. If the REQUESTED STUDY is likely to cost, in total, more than $1000, but funding increments are each planned to be less, approval through the ALG member and the
PCard office is necessary. If you are not sure of the eventual total, either seek the PCard exception approval ahead of time just in case, or pay for the REQUESTED STUDY using personal
funds and seek reimbursement when the REQUESTED STUDY is completed.
Receipts for every REQUESTED STUDY, including both the initial purchase receipt and the transaction record showing all the funds have been exhausted, must be submitted in hard copy
to the SCS Receipt Coordinator, even if the REQUESTED STUDY is set up for less than $75.