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73-179

(Rev.6-10/4) PRINT FORM CLEAR FORM

Payment Cancellation Voucher


Used by agencies to request cancellations for held warrants, reinstated warrants, postdated payroll deduction warrants or direct deposit payments to be processed by the Comptroller's office.
1. Check appropriate box 2. Current Document Number

Type: Warrant Deduction warrant C C D C Z


Warrant Direct deposit USAS deduction/reinstated warrant

Direct deposit Reinstated warrant 4 C C 7 C C


Payroll voucher Annuity voucher

3. Agency no. 4. Agency name 5. Document amount 6. Audited by 7. Effective date

8. Line no. 9. Payment/warrant number 10. Amount 11. Issue date 12. Texas Identification Number 13. Reason code

14. Original Current Doc No. 15. Fund 16. PCA 17. Comp obj 18. AY 19. Payee name

8. Line no. 9. Payment/warrant number 10. Amount 11. Issue date 12. Texas Identification Number 13. Reason code

14. Original Current Doc No. 15. Fund 16. PCA 17. Comp obj 18. AY 19. Payee name

8. Line no. 9. Payment/warrant number 10. Amount 11. Issue date 12. Texas Identification Number 13. Reason code

14. Original Current Doc No. 15. Fund 16. PCA 17. Comp obj 18. AY 19. Payee name

8. Line no. 9. Payment/warrant number 10. Amount 11. Issue date 12. Texas Identification Number 13. Reason code

14. Original Current Doc No. 15. Fund 16. PCA 17. Comp obj 18. AY 19. Payee name

8. Line no. 9. Payment/warrant number 10. Amount 11. Issue date 12. Texas Identification Number 13. Reason code

14. Original Current Doc No. 15. Fund 16. PCA 17. Comp obj 18. AY 19. Payee name

20. Contact name 21. Authorized by 22. Title 23. Phone (Area code and number) 24. Date

25. Payment reason codes: 26. Document reason codes:

301 Incorrect PIN 309 Leave without pay 317 Incorrect PIN
302 Incorrect amount 310 Termination 318 Incorrect amounts
303 Unable to deliver warrant 311 Retirement 319 Unable to deliver warrants
304 Warrant on hold (incorrect PIN) 312 Deceased 322 Stop payment (payment lost or destroyed)
305 Warrant on hold (cancel by agency) 313 Levy (IRS, bankruptcy, etc.) 323 Duplicate payment from state/local
306 Warrant lost or destroyed 314 Incorrect routing number 324 Payment not due
307 Duplicate payment 315 Incorrect or closed account 330 Document cancelled. Other ________________________________________________________
308 Payment not due 316 Other _____________________________
Form 73-179 (Back)(Rev.6-10/4)

Instructions for Completing the Payment Cancellation Voucher (PCV)

Item 1 - Type - Check the appropriate box for the type of payment to be cancelled. Item 12 - Texas Identification Number (TIN) - 14-digit TIN to whom the payment was issued.
Warrant Deduction warrant
Direct deposit Reinstated warrant Item 13 - Reason code - Use codes 301-316 when cancelling a single payment. Use 317-330
when cancelling an entire document with multiple payments.
Item 2 - Current Document Number (CDN) - This is a field that will identify the cancellation docu-
ment. Depending on the type of cancellation to be processed, the agencies will complete Item 14 - Original Current Document No. - Current Document Number of the payment document
the last characters of this field. The following are the six types of CDNs and the number (payroll, purchase or travel) from which the payment being cancelled was issued.
of digits the agencies must provide:
Item 15 - Fund - Appropriated fund number.
• Warrant Cancellation - the last 3 characters
• Direct Deposit Reversal - the last 3 characters Item 16 - PCA - Five-digit Program Cost Center.
• USAS Deduction Warrant - the last 3 characters
• Reinstated Warrant - the last 3 characters. Item 17 - Comp obj - Four-digit Comptroller object code.
• Payroll Voucher - the last 2 characters
• Annuity Voucher - the last 2 characters Item 18 - AY - Appropriation year.

Item 3 - Agency number Item 19 - Payee name - Name to whom payment was issued.

Item 4 - Agency name Item 20 - Contact name - Name of person who will respond to questions regarding the PCV.

Item 5 - Document amount - Total of all payments to be cancelled. Note: Will autocalculate from Item 21 - Authorized by - Signature of person authorizing the PCV. There must be a signature,
amount field if PCV is entered online. or the PCV will be rejected to the agency.

Item 6 - Audited by - Leave blank. For Comptroller’s use only. Item 22 - Title - Title of the person authorizing the PCV.

Item 7 - Effective date - Leave blank. For Comptroller’s use only. Item 23 - Phone - Area code and phone number of the contact person.

Item 8 - Line no. - Assign consecutive line numbers in ascending order per payment to be Item 24 - Date - Date the PCV was completed.
cancelled.

Item 9 - Payment/warrant no. - Nine-digit warrant number or seven-digit direct deposit Submit one original to: Comptroller of Public Accounts


payment number. ATTN: Fiscal Management Division
111 East 17th Street
Item 10 - Amount - Amount of each payment to be cancelled or reversed. Austin, TX 78774-0100

Item 11 - Issue date - Date the warrant or direct deposit payment was issued. Questions? Call (512) 936-8138, or e-mail tins.mail@cpa.state.tx.us.