=====================Organizational Data========================
Name of Organization : __________________________________________________________ Address:_____________________________________________________________________ Representative Name and Title:____________________________________________________ Phone:_____________________Fax:_____________________EMAIL:___________________ Year Established:__________Employee Identification Number (EIN):_________________________ DUNS Number:__________________________________________________________________________________ Organization Type: Non-Profit________For Profit _________Educational_______State/Local Govt________ Description of Service/Product: ____________________________________________________________________ Approx. Number of Employees: Full-time ____________________Part-time ____________________ ====================Federal Audit Data====================== Prior Audits/Reviews: OMB A-133_____Incurred Cost_____Accounting System_____Timekeeping ____ Date of Last Federal Audit/Review :_____________ Audit Agency/Firm:_________________________ If Findings Reported, Explain:_______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ===============Financial Statement Audit Data================ Date of Last Financial Statement Audit: ___________Fiscal Period Audited:_________________ Audit Firm: ___________________________________________________________________ Auditor’s Opinion on Financial Statements Qualified: Yes______________ No______________ If Qualified Opinion, State Reason: ___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 1/99 1 of 2 |
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What books of account are maintained? General Ledger YES____ NO____ Cash Receipts Journal YES____ NO____ Project Cost Ledger YES____ NO____ Payroll Journal YES____ NO____ Cash Disbursements Journal YES____ NO____ Does the accounting system provide for the recording of grant/contract costs according to categories of the approved budget? YES____ NO____ Does the system identify the receipt and expenditure of funds separately for each grant or contract? YES____ NO____ Does the system provide for the recording of cost sharing/matching for each project, and ensure that documentation is available to support recorded cost sharing/matching? YES____ NO____ Does the system provide for the recording of participant support costs as a separate cost category? YES____ NO____ ==================Timekeeping System Data================== Are time distribution records maintained for each employee to account for his/her TOTAL effort (100%)? YES____ NO____ (Attach a sample timesheet and procedures for completing timesheets and for allocating salary and wage charges to Federal awards.) Is your organization familiar with the time and effort reporting requirements related to Federal awards made to your type organization? YES____ NO____ =====================Purchasing System=====================
Are asset inventory records maintained? YES____ NO____ Does your organization have policies relating to buy/lease analysis and competitive purchases over $25,000? Yes_____ NO____ What is the dollar threshold for capitalization of equipment? $___________ =====================Funds Management===================== Is a separate bank account maintained for Federal grant/contract funds? YES____ NO____ If a separate bank account is not maintained, can the Federal grant/contract funds and related expenses be readily identified? YES____ NO____ Does your organization have procedures in place to minimize the time elapsing between the transfer of funds to your organization by a Federal agency and your organization’s expenditure of such funds? YES____ NO____ Prepared by:________________________________________________ Date:_________________ Name & Signature 2 of 2 |