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New Jersey Department of Children and Families Policy Manual




Child Protection and Permanency

Effective Date:













CP&P Form 16-81, Petty Cash Replenishment Request Memo




Click here to view or print CP&P Form 16-81, Petty Cash Replenishment Request.




The Petty Cash Replenishment Request Memo is used to request replenishment funds from the Office of Accounting. The request is made when 50% of the total imprest fund has been spent.




The form is a template in which clicking beneath each of the capitalized headings on the form or on any $0.00 results in a box appearing which can be filled in with Data. Examples: DATE DISBURSED, ITEM PURCHASED, etc.


At “kindly replenish our petty cash …” near the top of the page, identify the time period during which the expenditures were incurred. The time period starts with the date of the last replenishment request and ends with the date of the current replenishment request.


Next, as indicated, enter the total amount of the imprest fund, followed by the “Fund balance at start of period”.


The DATE DISBURSED is the date on which the actual petty cash reimbursement to employees occur. This column is listed in chronological order.


ITEM PURCHASED specifically describes the item for which petty cash funds have been used.


EMPLOYEE NAME is the staff person making the purchase


CLIENT NAME is the “Last name, First name” of the CP&P client for whom purchase was made.


NJ SPIRIT ID# reflects the Claim for Payment (CFP) case number for the CP&P client involved.


ITEM COST is the exact amount of the purchased item as reflected on the original receipt.


Under CHECKS RECEIVED enter the amount and check number of each check replenishment received from Accounting during the period.  Then adjust the FUND BALANCE accordingly and post the date of receipt. Fund Balance reflects the actual amount of cash still on-hand at the petty cash location as of completion of each individual transaction.


Enter the actual cash on hand at the bottom section entitled “Current Account Balance”. This amount should be equal to the subsequent heading, “Current Petty Cash on Hand”.


The next line at bottom, “Prior replenishment submitted but check not received”, is the amount of funds for which reimbursement has been requested from Accounting but has not yet been received.


Next enter the exact amount of the approved total petty cash Imprest Fund Amount for your location. (This amount will be equal to the total authorized Imprest fund.


1.    The Replenishment Request is approved via original signature by the location manager LO or Director AO).


2.    Print at bottom, the name of the person authorized to receive the petty cash replenishment check from Accounting.




Original  -  Accounting, Cost Code #973


Copy      -  Petty Cash Replenishment File