Contents of an FS-80 Notice of Overpayment

 

Agency Code:  
Project #:  

Contract #: C4_________

Agency Name:  
Funding Source:
Contact Person:

An audit of the attached Final Expenditure Report (FS-10-F) for the above referenced project has been completed. Based on the audit an overpayment has been calculated as follows:

1. Amount accepted by audit

 $__________

2. Payment to date

$__________

3. Overpayment

$__________

____  Please issue a check in the amount of overpayment to "Treasury of the State of New York" and remit directly to the address noted above. If refunds are due on more than one project, separate checks must be submitted for the amount due on each project. If payment is not received by Grants Finance within 30 days of the date of this notice, ALL subsequent grant and grant contract payments will be held until the overpayment has been remitted. Please return a copy of this notice with the refund check.

____  A refund check is not required. The overpayment on this project has been transferred to project number ____________________.

If you have any questions concerning the audit or overpayment procedures, please contact this office.

Auditor _________________________         Date ___________________

Date check sent to accounting: __________________

FOR DEPARTMENT USE ONLY

Fund/Year

Line #

Refund Amount
Refund #:      
Check #:      
Entered:      
Initials:      

Revised 10/09