04. Applicant Organizational Information Sheet.docx

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Workforce Integration in Conflict Areas
Opportunity number
SCAISB-26-CA-002-02242026
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This is a required application template for organizational information that applicants must complete in full to apply for federal grant opportunities, specifically the Workforce Integration in Conflict Areas cooperative agreement administered by the U.S. Department of State's Embassy Islamabad under the Public Diplomacy Programs for Afghanistan and Pakistan (CFDA 19.501).

The form requires comprehensive disclosure across six major sections: general organizational information including legal entity status, incorporation details, and key personnel contacts (Program Director and Financial/Business Official); organizational structure covering board governance, employee count, DUNS/UEI registration, and authorized signatories; financial and accounting management systems including fiscal year-end date, accounting system capabilities, general ledger posting frequency, cost tracking by grant, indirect cost rate agreements, and authorized payment signatories; tax liability and criminal conviction representations; business management systems documenting knowledge of 2 CFR 200 requirements and written policies covering personnel, procurement, cash management, subgrant monitoring, property, travel, anti-nepotism, and trafficking in persons procedures; and audit history including dates, types (program-specific or single audit), adverse findings, and prior government funding experience over the past five years. Organizations must provide explanations rather than "Not Applicable" responses, maintain time and activity records by funding source and project, demonstrate separation of duties, and document all awards received in the previous five years, with particular notation of U.S. Government funds. The applicant must certify the accuracy of all statements by authorized representative signature with title and date.

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Attachment 04. Applicant Organizational Information Sheet

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Appendix 2 Required Document Applicant Organizational Information

APPLICANT ORGANIZATIONAL INFORMATION SHEET

Instructions: The Applicant Organizational Information Sheet should be filled out in its entirety. Please note that the response “Not Applicable,” or “N/A,” is generally not acceptable. Instead, a sufficient explanation should be provided to explain why an item is not applicable.

GENERAL INFORMATION

1. Organization Name:
2. Assessment Completed By:
Title:

3. Type of Organization (check all that apply)

Non-U.S. Based:
|_|
Non-Profit:
|_|
Non-

Governmental:

U.S. Based:
|_|
For-Profit:

(Commercial)

|_|
Educational

Institution:

4. Is your organization incorporated, registered, or licensed as a legal entity: |_| Yes |_| No

If Yes:
Place of Incorporation or Registration (State/County):
Incorporation or Registration Date (MM/DD/YYYY):
If No:
List parent company or organization name and address OR explain status below:

5. Program Director (The person who will oversee the day to day activities of the award):

Program Director Name:
Program Director Title:
Email Address:
Telephone Number:
Address:

6. Financial or Business Official (The person who is responsible for the financial components of the award):

Budget Officer Name:
Budget Officer Title:
Email Address:
Telephone Number:
Address:

ORGANIZATION STRUCTURE

1. Is your organization governed by Board of Directors?
|_| Yes |_| No
If Yes:
Has your Board authorized your organization to enter into this grant/cooperative agreement?
|_| Yes |_| No
If Yes:
Provide documentation indicating Board approval.
2. How many employees are employed by your organization?
3. Is your organization registered with Dun and Bradstreet (DUNS) UEI and the System for Award Management (SAM)?
|_| Yes |_| No
If No, please explain:

4. List all individuals authorized to sign award and amendment documents on behalf of your organization:

Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:

FINANCIAL AND ACCOUNTING MANAGEMENT

1. What is the ending date of your organization’s fiscal year (MM/DD/YYYY)?
2. Does your organization have an automated accounting system?
|_| Yes |_| No

2.1: If Yes, respond to the questions below:

2.1a Does the accounting system account for costs by individual projects?
|_| Yes |_| No
If No, please explain:
2.1b Can the accounting system generate reports that show costs incurred for individual awards?
|_| Yes |_| No
If No, please explain:
2.1c Does the accounting system allow for reporting of Cash and In-kind contributions (from non-federal sources) i.e., cost share?
|_| Yes |_| No
If No, please explain:
3. Which of the following best describes your organization’s accounting system? (check the appropriate response)
Manual:
|_|
Automated:
|_|
Combination:
|_|
Other:
|_|
4. How frequently do you post to the general ledger? (check the appropriate response)
Daily:
|_|
Weekly:
|_|
Monthly:
|_|
Other:
|_|
5. Does your accounting system accurately and completely track receipt and disbursement of funds by each grant and/or funding source?
|_| Yes |_| No
If No, please explain:
6. Does your accounting system provide for recording of actual expenditures for each grant/contract by budget cost categories reflected in the approved budget?
|_| Yes |_| No
If No, please explain:
7. Does your organization have a NICRA (Negotiated Indirect Cost Rate Agreement)?
|_| Yes |_| No

8. List all individuals authorized to sign payment requests and financial reporting on behalf of your organization:

Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:

REPRESENTATION REGARDING TAX LIABILITY OR CRIMINAL CONVICTION

1. Has your organization been convicted of a felony criminal violation under a Federal law within the preceding 24 months?
|_| Yes |_| No
2. Does your organization have any unpaid Federal tax liability that has been assessed for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability?
|_| Yes |_| No

BUSINESS MANAGEMENT SYSTEMS

1. Does the organization have a working knowledge of the following U.S. Government, Office of Management and Budget (OMB) Requirements? (check the appropriate response)

2 CFR 200 Uniform Administrative Requirements, Costs Principles, and Audit Requirements for Federal Awards:
|_| Yes |_| No |_| Not Sure

2. Does your organization have written policies and procedures for the business management areas below? (check the appropriate response)

Personnel Policies and Procedures:
|_| Yes |_| No |_| Not Sure
Procurement Policies and Procedures:
|_| Yes |_| No |_| Not Sure
Cash Management Policies and Procedures:
|_| Yes |_| No |_| Not Sure
Sub-Grant Monitoring and Management:
|_| Yes |_| No |_| Not Sure
Property Policies and Procedures:
|_| Yes |_| No |_| Not Sure
Travel Policies and Procedures:
|_| Yes |_| No |_| Not Sure
Anti-Nepotism Policy
Yes No Not Sure
Trafficking in Persons (TIP) Procedures:
|_| Yes |_| No |_| Not Sure
If No (to any above), please explain:
3. Are time and activity records maintained by funding source and project for each employee to account for total level of effort (100%) devoted to each project?
|_| Yes |_| No
If No, please explain:
4. Does your organization have a written budgetary process and controls to prevent incurring obligations in excess of the grant amount for individual cost categories?
|_| Yes |_| No
If No, please explain:
5. Are appropriate duties separated to ensure one individual (i.e., project or financial) is not controlling all aspects of a transaction/process?
|_| Yes |_| No
If No, please explain:
6. Has your organization ever undergone an audit?
|_| Yes |_| No
If Yes:
Give the date of your last audit:

What type of audit was it? (check the appropriate response)

|_| Program-specific Audit – an audit of a Federal award program |_| Single Audit – an audit that includes both the organization’s financial statements and the Federal Awards to be conducted |_| If it was another type of audit, please explain:

|_| Not Sure

Has your organization received any adverse findings in any audit in the past three years?
|_| Yes |_| No
If Yes, please explain:
7. Has your organization received grant funds before?
|_| Yes |_| No
If Yes:
Did your organization expend $750,000 or more in U.S. Government funds in the previous year?
|_| Yes |_| No

7.1 Please provide the information requested below on all awards or funding received in the last five years, specifically note if funds are U.S. Government (USG) funds.

Name of Donor
Amount
Period
Place of Implementation

*By signing this application, I certify that the statements herein are true, complete and accurate to the best of my knowledge.

Signature of Authorized Representative:

Title:
Date:

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