Patients/Research Volunteers
F Fees and Expenses Claim Form
Please read the Guidance Notes attached before completion
Personal DetailsSurname / First Name(s) / Title / Gender / M / F
National Insurance No. / Date of Birth / Current Age / Nationality
Home Address / Post Code
Email Address / Tel No:
Bank Sort Code / Bank Account Number
Fees/Expenses
Description of Patient/Research Participant duties
Start Date / End Date / No. of Days / No. of Hours
Mileage / No. of Miles: / Mileage Amount: / £ / Transport / £ / Hotel / £ / Meals / £
Was your journey to/from the University of Salford? / YES / NO / If ‘No’ please state destination(s):
Total Fee Claimed: / £ / Total Expenses Claimed: / £
Claimant Declaration
I declare that this is a true statement of fees/expenses wholly and necessarily incurred whilst engaging in research/patient tests/interviews for the University of Salford and this claim is made in accordance with both University and HMRevenue & Customs regulations(see overleaf).
This form must be printed and signed – electronic signatures are not acceptable
Signed / Date
Authorisation by School Operations/Professional ServicesManager
I have verified the Personal Details of this claimant and can confirm the claimant took part in research as a volunteer/patient and this payment is to cover out of pocket expenses/compensation for time spent. I confirm this is a one-off/ad-hoc arrangement and authorise this claim for payment in accordance with University and HM Revenue & Customs regulations(see overleaf).
Signed / Date
Print Name / College/School/ Professional Service
Contact Name for Queries / Tel. Ext. for Queries / Project Code
for PayrollSection Use only
Authorised Signature checked by / Input by & date / Audited by
GUIDANCE NOTES
General
This form mustonly be used for the payment of fees and expenses for research volunteers, lay participants and participants in clinical trials,in accordance with HM Revenue & Customs (HMRC) legislation as below.
HM Revenue & Customs Legislation
In the course of undertaking research, particularly social science or medical research, volunteers may be required to take part in tests, submit to measurements, be interviewed, or attend meetings to give their views on various matters to inform the research process and direction. These participants are often former or current patients, representatives of particular groups such as retired people, or representatives from charities, and are paid a small sum to cover out of pocket expenses and compensation for time spent.
There are no tax consequences for the University in these circumstances as HMRC agrees that the amounts paid to those concerned are unlikely to fall within the definition of earnings for Pay As You Earn and National Insurance purposes, as no employment relationship exists.There will be no tax or NIC liability arising on the individual if the sums received do no more than reimburse the individual’s reasonable costs of participating in the trial or research, including costs of travel and subsistence.
This form must not be used to claim fees/expenses for work carried out for which payment must be made as earnings.
All fields are mandatory and the claimant must sign the ‘Claimant Certification’. It is the responsibility of the Academic/Professional Services area to ensure the form is fully completed and the information is printed clearly. If any of the fields are incomplete (including the Claimant Certification) or illegible, the form will be returned to the originating Academic/Professional Services area.
Receipts
All receipts for expenses must be attached to the claim before submission.
Payment
Payment is made by bank transfer only (there is no facility to issue cash/cheques). Payment to an international bank account incurs additional charges, which will be deducted from the payment (unless indicated otherwise by the authorising signatory). The full bank name, full postal address, IBAN number (if applicable) and the relevant BIC/SWIFT/Routing/Clearing Code must be provided or the claim form will be rejected, which may result in a delay in payment.
Claimant Declaration
The claimant must sign the form to confirm the fees/expenses have been incurred in accordance with the above legislation and no other claim has been made, or will be made, to the University (or any other public body) for any related fees/expenses.
Authorisation by School Operations/Professional Services Manager
Forms must be signed by the relevant School Operations/Professional Services Manager (they must be an ‘Authorised Signatory For Finance’) to confirm that the payment complies with the above legislation and no other claim has been made, or will be made, to the University (or any other public body) for any related fees/expenses.
This form cannot be submitted to the Payroll Section directly from the claimant; it must be sent to the originating Academic/Professional Services area for authorisation. All authorised forms must then be scanned as PDF documents and emailed to the Payroll Mailbox () from an internal email account (by a member of staff), to comply with audit requirements.
Contact
If you have any queries or require further information, please contact the Payroll Section on 0161 295 4193, or email form can be printed from the Finance website at: