Cardholder Name: ___________________________________________

Department Name: _____________________________________

Cardholder's Approving Official Name: ___________________________________________

Today's Date: ____________

Transaction ID #: ___________________________________________

Transaction Date: _____________________________________

Merchant Name: ___________________________________________

Transaction Amount: $____________________________________

TYPE OF VIOLATION
The following ACARD violation has been found in reference to the above transaction.
Approving Official Instructions– obtain informaton from the Cardholder about why this purchase was made on his/her ACARD. Mark the appropriate category below. See Approving Official or Cardholder Handbook for details on recognizing a violation.

• ______ PERSONAL PURCHASE
• ______ CASH TRANSACTION
• ______ SPLIT PURCHASE
• ______ INAPPROPRIATE PURCHASE:
• ______ Contract requiring authorized signature
• ______ Drug Enforcement Agency Licensed Substance
• ______ Furniture
• ______ Radioactive Material
• ______ Restaurant Meals (Unless cardholder has been granted an exception for official functions)
• ______ Travel & Travel related expenses
• ______ Vehicle Expenses
• ______ Services Note: Services from on-campus departments are not violations
• ______ LACK OF DOCUMENTATION Note: Unavailable Documentation Form must be completed and attached.
• ______ UNALLOWABLE PURCHASE UNDER THE TERMS OF APPLICABLE SPONSORED PROJECT

CARDHOLDER EXPLANATION - Explain why this purchase was made on a University credit card and information on what has been done to correct the situation. Attach additional sheet if necessary.

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

APPROVING OFFICIAL DETERMINATION, CERTIFICATION SIGNATURE, ACTION - Mark appropriate category and take the actions listed. Instructions for making the determination are below.
_____	I hereby acknowledge that the above transaction is a violation of the ACARD policies and I further acknowledge that the Cardholder has been warned through the use of this form. The ACARD will not be revoked at this time.   Actions - 1) obtain the Cardholder's signature on this form, 2) send the original of this completed form, along with the documentation for the above transaction to Buying and Contracting, ACARD Program Administration, Campus Box 578, 3) log the transaction as a violation in the ACARD System, 4) keep a copy of this completed form with the Cardholder's Statement and/or in a separate "violations file" in the department, 5) give a copy of this form to the Cardholder.
_____	I hereby acknowledge that the above transaction is in violation of ACARD policies and the ACARD is being revoked at this time.   Actions - 1) notify the cardholder in writing that their ACARD is being revoked, 2) retrieve the card from the Cardholder and destroy it, 3) notify Buying and Contracting ACARD Program Administration that the card has been revoked and request immediate card cancellation with the bank.

Approving Official Name: ______________________________________

Signature: ______________________________________

Date: _______________

CARDHOLDER CERTIFICATION SIGNATURE - I hereby acknowledge that the above transaction is in violation of the ACARD policies. I further acknowledge that repeated violations could result in revocation of my ACARD. I further acknowledge that I have been warned through the use of this form. I understand that I am permitted to make purchases that are in compliance with ACARD policies and agree to refer to my ACARD Handbook or contact my Department Liaison or ACARD Program Administration if I am unsure about ACARD policies or instructions.

Cardholder Name: ______________________________________

Signature: ______________________________________

Date: _______________

The Approving Official must make a determination if a transaction is an ACARD violation or not. Instructions for making this determination are located in the Approving Official Handbook, Version 1. Once the determination has been made that a transaction is an ACARD violation, the Approving Official should follow the instructions below.

1. Obtain an explanation from the Cardholder of why this purchase was made on a University credit card and what has been done to correct the situation.
2. Review the Cardholder's ACARD violation history to determine if the Cardholder has repeatedly had ACARD violations. This history will contribute to the deicsion to warn the Cardholder or to revoke the ACARD.
   • You may run, or have someone with ACARD system access run, the Transaction Violation Report in the ACARD System and/or, if the department has kept a separate file of violations, check that file.

3. Determine the Card Status based on the following guidelines:
   For
   • Split Purchases
   • Inappropriate Purchases
   • Lack of Documentation which has been determined to be an ACARD violation
   • Personal Purchase which was immediately reported and reimbursed or credited by the merchant
     The status of a chronic violator is determined by the Approving Official. He/She will investigate the number and nature of Cardholder’s violations and their impact on the department and the University. The Approving Official will use sound judgement to arrive at his/her conclusion. The determination may be made in consultation with the Department Liaison and/or with Buying and Contracting ACARD Program Administration.
   • Card Status - ACARD will not be revoked at this time - If the Cardholder ACARD history indicates that the Cardholder does not chronically have violations of any type, the Approving Official may determine that the card will not be revoked at this time. A second offense where an inadvertent personal purchase was made and reported is cause to revoke the ACARD.
   • Card Status - ACARD will be revoked at this time - If the Cardholder ACARD history indicates that the Cardholder has a chronic history of violations of any type, the Approving Official should determine that the card will be revoked.

   For

   • Personal Purchase which was not immediately reported and corrected
   • Cash or Cash Type Transaction
   • Lack of Documentation which has been determined to be an ACARD Violation and Suspected Fiscal Misconduct
   • Card Status - Violation and Suspected Fiscal Misconduct
     Suspected Fiscal Misconduct is to be reported directly to Internal Audit per the University of Colorado Administrative Policy Statement entitled "Reporting Fiscal Misconduct". This policy statement can be found on the web at http://www.cusys.edu/~policies/Fiscal/fiscalmis.html. Do not proceed further with steps 4-6 below. Contact Buying and Contracting ACARD Program Administration to inform them of the actions being taken.

4. Indicate the appropriate determination in the "APPROVING OFFICIAL DETERMINATION, CERTIFICATION SIGNATURE, ACTION" section on the front of this form.
5. Obtain the Cardholder signature in the Cardholder Certification Signature section on the front of this form.
6. Take the actions listed for the appropriate category indicated on the front of this form.