Change in Accounts Form 
INSTRUCTIONS 
The Change in Accounts Form must be completed and reviewed to ensure accuracy.  Your signature below confirms
that the information presented is complete, accurate and authorizes Budget and/or Grant Accounting to enter the
above account changes.
The Form should be submitted to Budget and/or Grants Accounting at least 15 work days prior to the “Effective Date” of
the change.
Except for cases where agency rules or grant expiration apply, Change in Accounts forms should not be submitted in
excess of four (4) times throughout the year (fiscal/calendar).
Time and Effort reports must coincide with the account information stated on the change in accounts form relative to
the period covered.
The chain of approval is as follows; Department Head → Component Head → Budget → Grant Accounting.
Percentage (%) must be in whole numbers.  Please round the percentage to the nearest whole number.
EMPLOYEE INFORMATION 
Employee Name: 
Employee ID: 
Job Title: 
Position Number : 
Department 
     LABOR DISTRIBUTION INFORMATION 
FUND 
ORGN 
ACCT 
PROG 
% 
Account 1 Name 
Account Number 
Account 2 Name 
Account Number 
Account 3 Name 
Account Number 
Account 4 Name 
Account Number 
Account 5 Name 
Account Number 
Account 6 Name 
Account Number 
Account 7 Name 
Account Number 
Effective Date (mm/dd/yy) 
End Date (mm/dd/yy) 
REASON FOR CHANGE 
APPROVAL 
Department Head 
Component Head 
Budget 
Title III 
Grants Accounting 
Print Name 
Print Name 
Signature 
Signature 
Date 
Post Date 
CC: HR File 
SIGN
SIGN
SIGN
SIGN