Instructions for
Delegated Signature Authorization
This form is used to delegate expenditure decision authority to an employee per OAM 10.40.10.00. Any person who
exercises expenditure decision authority shall be legally responsible and accountable for the expenditure.
Appropriate segregation of duties must be maintained ensuring an individual does not both authorize and purchase a
service or supply.
The manager delegating the authority and the designated employee must sign the form. A new form must be
completed if you have a name change, position change, or delegating manager change. For questions about this form,
contact the Office of Financial Services at 503-945-5638.
*NOTE: Managers may not delegate more authority than they are authorized to have. The manager delegating
the authority must keep a copy of the form on file and send paper or electronic form to the Office of
Financial Services.
Field definitions
Agency: Select your agency. Mark shared if you are a shared service and have delegation under both agencies.
Employee name (printed): Your name should match your name on file with Human Resources.
Employee ID: Your state identification number (OR number) assigned by the agency. – This number can be found
on your check stub.
Worksite address: Your work address, city and zip.
Office name: The name of your office.
Email: Your state email address.
Work phone: Your current work phone number including extension, if applicable.
Employee signature: Your legal signature that is how you intend to sign all documents.
Delegation types: Select appropriate delegation types by entering an “x” in box provided.
Payments: Needed if you approve invoices for payment. By signing payment requests, you are ensuring the
proper accounting codes are used.
Contract authorization: Needed if you approve contract requests or contracts. Contract overview training is
recommended for this delegation type.
Note: SRO’s (Service Release Order) are considered invoices and fall under invoice payment delegation.
Dollar limit is the total not –to-exceed, including all amendments.
Purchase orders: Needed if you approve purchase orders or requisitions.
Travel advances: Needed if you approve travel advances.
Travel claims: Needed if you approve travel claims in TRIPS.
SPOTS Visa logs: Needed if you approve SPOTS visa logs. SPOTS manager training is required for this
delegation type.
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SPOTS Visa applications: Needed if you authorize staff to have a SPOTS Visa.
Note: Authority generally granted to executive level managers. Dollar limit is not required.
Time capture/leave slips: Needed if you approve time lock and leave requests.
Note: Dollar limit is not required.
Other [Select]: Enter description of other delegation.
Items may include other financial delegations such as Interagency Agreements, etc.
Dollar limit: You must enter a specific dollar amount to authorize expenditure delegation. The dollar amount must
not exceed sub-delegating manager’s authorized dollar amount. The dollar limit is per instance/per
transaction.
Note: “LAB” (Legislative Approved Budget) may be used in the dollar limit field for
executive management. Since dollar limits are per instance/transaction, delegation amounts in
millions are generally not appropriate for most individuals.
Sub-delegate: Indicate “yes” if the individual is allowed to further delegate authority to a sub-ordinate.
The delegating manager must have sub-delegation authority on file to further delegate to
designated employee.
Program: Identify program name in which the individual has delegated signature authority.
Office/unit: Identify the office or unit name in which the individual has delegated signature authority.
(Example: La Grande Self Sufficiency Office)
Grant/project (if applicable): Identify the grant or project (or grant/project number) in which the individual has
delegated signature authority. (Example: SHAP Grant or ORKIDS Project).
Note: Not all areas of delegation (program, office, grant/project) are required fields – Complete only
those fields that are relevant to the delegation.
Effective start date: The date the delegation starts and may not be earlier than the date of the manager’s
signature date.
Manager name (printed): Your name as stated on your signature authorization form.
Manager title: Your position title.
Manager ID: Your state identification number (OR number) assigned by the agency.
Manager email: Your state email address.
Signature date: The date the delegated signature authority form is signed.
Rescind signature authority: When an employee resigns from DHS/OHA, or no longer needs delegated authority,
complete the “Rescind signature authority” portion and mail paper or electronic form
to the Office of Financial Services. This needs to be done within 30 days of
employment change.
Effective end date: The date the delegation ends.
Mail completed form (paper or electronic) to:
DHS/OHA Office of Financial Services
500 Summer St. NE, E-82
Salem, OR 97301-1090
Email: [email protected]
For more information on the Policy and Procedure for Delegation of Expenditure Authority visit:
www.dhs.state.or.us/policy/admin/fs/040_010.pdf
www.oregon.gov/DAS/CFO/SARS/policies/oam/10.40.00.pdf
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SHARED SERVICES
Office of Financial Services
Delegated Signature Authorization
Agency:
Delegated employee information
DHS
OHA
Employee name:
Shared
Employee ID number:
OR
Work phone:
Worksite address:
Office name:
Email:
By signing below, I acknowledge that I have read and understand the applicable statutes, rules, policies and
manuals as referenced in Procedure DHS-040-010-01.
(Employee signature)
Delegation type
(Date)
Dollar limit
Subdelegate
Yes 
Office/unit
(name)
Program name
Grant/project
(if applicable)
Payments
(Invoice/contract)
Contract
authorization
Purchase orders
Travel advances
Travel claims
SPOTS Visa logs
SPOTS Visa
applications
Time capture/leave
slips
Other:
N/A
N/A
{Select one}
Manager delegation approval
Manager name:
Manager title:
Manager ID number:
OR
Manager email:
Manager signature:
Effective start date:
Signature date:
I assume full responsibility for delegation of signature authority to the above employee as indicated.
Rescind signature authority
Manager name:
Manager signature:
Effective end date
Manger ID number:
OR
Manager title:
Signature date:
MSC 286 (04/15)