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Annual Certification Statement

To collect a signed certification of effort expended on grant and contract accounts by monthly employees.

Selection Criteria
This report will use the same selection criteria as the Preliminary Account Distribution report. In addition, it will take into account any transactions processed during the current fiscal year, that affect the prior fiscal year being reported. 

As with the Preliminary Account Distribution report, the percentages of effort required to comply with Department of Health and Human Services’ salary caps, will be calculated and displayed on the Annual Certification Statement. 

Use By Department
Signed and dated forms will be due in the Payroll Department by the date specified during the distribution process. No payroll adjustments can be processed using the Annual Certification Statement as an input document. 

Distribution Procedure
The reports are distributed to the individual’s "responsible department" indicated on the payroll system, and are alphabetical, by employee, within each department. 

If the department receives an Annual Certification Statement that does not belong to the department please contact the Payroll Department’s Effort Reporting Coordinator immediately at (773) 834-3533 for instructions.  

Annual Certification Statement [PDF]