Applicant Organization Survey Rev FY17 - SCAPPD Edits.docx

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Programs to Counter Violent Extremism and Foster Community Resilience, Public Affairs Section, U.S. Embassy Islamabad
Opportunity number
SCAISB-17-AW-002-03062017
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Applicant Organization Survey

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Appendix 2 Required Document Applicant Organizational Information

Required Document Organization Survey

GENERAL INFORMATION

1. Organization Name:

2. Type of Organization (check all that apply) Pakistan-based:

Non-Profit:

U.S.-based:

For-Profit:

(Commercial)

3. 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:

If No:
List parent company or organization name and address OR explain status below:

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

Program Director Title:

Email Address:

Address:

Telephone Number:

5. Financial Official (The person who is responsible for the financial components of the grant):

Financial Officer Title:

Email Address:

Address:

Telephone Number:

ORGANIZATION STRUCTURE AND POLICIES

1. Is your organization governed by Board of Directors?
|_| Yes |_| No

2. How many employees are employed by your organization?

3. Does your organization have a written personnel policy and procedure manual?
|_| Yes |_| No
4. Does your organization have a written accounting and financial policy and procedure?
|_| Yes |_| No
5. Does your organization have written policies and procedures for monitoring sub-awardees or sub-recipients, including consultants?
|_| Yes |_| No
6. Are the Program Director and Financial Official(s) familiar with U.S. Government grant regulations?
|_| Yes |_| No

FINANCIAL AND ACCOUNTING MANAGEMENT

7. What is the ending date of your organization’s fiscal year? (MM/DD/YYYY)

8. Does your organization have an automated accounting system?
|_| Yes |_| No
If Yes:
Can the accounting system show amounts incurred for individual awards and show charges to separate funding sources?
|_| Yes |_| No
Can the accounting system generate reports that show these specific costs incurred for individual awards?
|_| Yes |_| No
Does the accounting system allow for reporting of Cash and In-kind contributions (from non-federal sources) i.e., cost share?
|_| Yes |_| No
9. Which of the following best describes your organization’s accounting system? (check the appropriate response)
Manual:
|_|
Automated:
|_|
Combination:
|_|
Other:
|_|
10. How frequently do you post to the general ledger? (check the appropriate response)
Daily:
|_|
Weekly:
|_|
Monthly:
|_|
Other:
|_|
11. Does your organization have a NICRA or a written policy and percentage for indirect costs?
|_| Yes |_| No

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

12. Are there written procedures for determining reasonableness, allocability, and allowability of costs?
|_| Yes |_| No
13. Does your organization prepare annual financial statements (e.g., balance sheet, income and expense statement)?
|_| Yes |_| No
14. 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
15. Does your organization have a written budgetary process and controls to preclude incurring obligations in excess of the grant amount of individual cost categories?
|_| Yes |_| No
16. Are appropriate duties separated to ensure one individual (i.e., project or financial) is not controlling all aspects of a transaction/process?
|_| Yes |_| No
17. Has your organization ever managed and monitored sub-awards to another organization?
|_| Yes |_| No
18. 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:

19. Has your organization received grant or agreement funds before? (Yes or No):
|_| Yes |_| No
If Yes:
Did your organization expend $750,000 or more in U.S. Government funds in the previous year?
|_| Yes |_| No

9.1 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
USG Funds?

(Yes or No)

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