15-Attachment W - Pre-Award Risk Questionnaire (Subrecipients) (1).pdf

Attachment W

AMERICAN RESCUE PLAN OF 2021 (ARPA)

Pre-Award Risk Questionnaire (Subrecipients)

This attachment is for information purposes only and will not be required with proposal submissions.

In compliance with the Department of the Treasury (“federal grantor”), all subrecipients must complete this pre‐award risk questionnaire before entering into a sub‐agreement with the County. This questionnaire—combined with the County’s program staff assessment—will assist the County in determining any conditions/assistance to be included in your sub‐ agreement for work under this grant per 31 CFR 35. There are no predetermined answers that would automatically disqualify your organization from consideration for an award.

Organization Name:

Type of Organization Requesting Funding:

Organization Unique Entity Identifier

(DUNS #):

Organization Fiscal Year (Start & End Month): Date of Form Completion:

Completed by:

Name & Title: Email Address: Phone #:

Performance History

1. Has your organization received a federal award directly from an awarding agency in the past 5 years? If yes, please list the federal grantor agency name, time period, award amount, audit findings (and corrective actions/completion date(s)), and grant number.

2. In the preceding fiscal year, did your organization receive 80% or more of its annual gross revenue from federal funds? ☐

Yes ☐ No

3. In the preceding fiscal year, did your organization receive $25 million or more of its annual gross revenue from federal funds? ☐ Yes ☐ No

Management Systems & Personnel

1. In the past 5 years, has your organization managed grant funds, loans or other types of financial assistance from any of the following entities?

Federal ☐Yes ☐No

State ☐Yes ☐No

Harris County ☐Yes ☐No

Private ☐Yes ☐No

2. Does your organization have any new or substantially changed management systems (technological or other) in the past 12 months? If yes, please specify what has changed.

☐ Yes ☐ No

New/Changed Systems:

1.

2.

3.

3. Has your organization had changes to the following key staff or positions in the past 12 months? If yes, explain in the comments section.

Governing Body ☐ Yes ☐ No

Executive Management ☐ Yes ☐ No

Attachment X

Pre-Award Risk Questionnaire (Subrecipients)

Financial Officer ☐ Yes ☐ No

Risk Manager ☐ Yes ☐ No ☐ N/A Other Relevant (fill in)

4. Does your organization have capacity to manage and implement federal regulations, including 2 CFR 200 and specific federal funder regulations? If your organization does have experience using 2 CFR 200, please describe your experience below.

☐ Yes ☐ No ☐ No and Request Technical Assistance (Listed Below)

1.

2.

3.

Experience with 2 CFR 200 (Describe):

5. Does your organization have current staff with experience in this type of program?

☐ Yes ☐ No If yes, how many? If no, is there a staffing plan to hire?

6. Is the “total compensation” for your organization’s five highest-paid officers publicly listed or otherwise listed in SAM.gov1. If no, please enter the information for Name and Total Compensation below.

☐ Yes ☐ No

Name. If the number of officers is less than 5, please enter N/A for the respective row 1.

2.

3.

4.

5.

Total Compensation. The total compensation, as defined in 2 CFR part 170.330, earned by the five high-paid officers; if the number of officers is less than 5, please enter 0 for the respective row

1.

2.

3.

4.

5.

7. Is your organization’s system of internal controls reasonable in accordance with the applicable cost principles (including the segregation of duties, handling of cash, contracting procedures, and personnel and travel policies)?

☐ Yes ☐ No ☐ Unsure

1 Treasury SLFRF Compliance and Reporting Guidance Version 3.0 final https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting- Guidance.pdf

“As required by the 2 CFR Part 170, Appendix A award term regarding reporting subaward and executive compensation, recipients must also report the names and total compensation of their five most highly compensated executives and their subrecipients’ executives for the preceding completed fiscal year if (1) the recipient received 80 percent or more of its annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial assistance subject to the Transparency Act, as provided by 2 CFR 170.320 (and subawards), and received $25,000,000 or more in annual gross revenues from Federal procurement contracts (and subcontracts) and Federal financial assistance subject to the Transparency Act (and subawards), and (2) if the information is not otherwise public.”

Attachment X

Pre-Award Risk Questionnaire (Subrecipients)

Audit Reports and Findings

1. Has your organization had an audit or monitoring visit in the last 24 months?

☐ Yes ☐ No

If yes, what type of audit or visit? (Please send reports with this form)

2. Are there any unresolved audit or monitoring findings?

☐ Yes ☐ No If yes, what type and number of finding(s)?

Financial Stability

1. Which of the following best describes your organization’s accounting system?

☐ Manual ☐ Automated ☐ Combo

2. Does your organization have an accounting system in place to segregate expenditures by funding source?

☐ Yes ☐ No

If yes, what type of system?

3. Does your organization maintain central files for grants, loans, or other types of financial assistance?

☐ Yes ☐ No

Comments: Please use this section to provide additional information on the foregoing questions. Be sure to clearly list section and number on which you are providing comment.