Exhibit N - Federal Funding Accountability and Transparency Act (FFATA).pdf
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- Solicitation number
- HHS0017150
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Federal Funding Accountability and Transparency Act (FFATA) Federal Awards Certification form issued by the Texas Health and Human Services Commission (HHSC) for contractors seeking to work on federally funded projects. The form requires contractors to certify material facts regarding their federal funding sources and compensation disclosure practices, which HHSC reports to the federal government as required by federal law. Contractors must answer certification questions regarding gross income thresholds, the percentage of annual revenue derived from federal awards, and the amount of annual gross revenues received from federal awards. The form establishes that if a contractor cannot certify all statements, written notice must be provided to HHSC detailing which statements cannot be certified and the reasons. Additionally, contractors must provide immediate written notice to HHSC if any certification becomes incorrect due to changed circumstances.
The form contains four primary sections requiring contractor certification and signature. Section A addresses whether the organization received 80% or more of its annual gross revenue from federal awards in the preceding fiscal year. Section B requires certification regarding whether the organization received $25 million or more in annual gross revenues from federal awards. Section C mandates disclosure of highly compensated officers and senior executives if the organization meets certain thresholds, requiring either confirmation that public access to compensation information exists through Securities Exchange Act filings or Section 6104 of the Internal Revenue Code, or submission of the names and total compensation of the top five highly compensated officers. The form must be completed and signed by a duly authorized representative of the contractor, with required fields including the contractor's legal name, unique entity identifier, authorized representative's title and signature, date of signature, and applicable HHSC contract number(s). HHSC reserves the right to pursue all available remedies under Texas and U.S. law if the contractor knowingly renders an incorrect certification.
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Form 8040 December 2024 Federal Funding Accountability and Transparency Act (FFATA) Federal Awards Certification Texas Health and Human Services Commission Logo ..\..\..\MISC\Images\HHSC-Logo Images\HHS_Logo_BW_M.jpg The certifications listed below represent material facts that HHSC relies on when reporting information to the federal government required under federal law. If HHSC later determines that the contractor knowingly rendered incorrect certification, HHSC may pursue all available remedies per Texas and U.S. laws. The signer also agrees that they will provide immediate written notice to HHSC if at any time they learn that any of the certifications provided for below were wrong when submitted or have since become wrong by reason of changed circumstances. Note: If the signer cannot certify all the statements contained in this section, they must provide written notice to HHSC detailing which of the below statements they cannot certify and why.
Did your organization have a gross income, from all sources, of less than $300,000 in your previous tax year?
Section A – Certification About Percent of Annual Gross from Federal Awards Did your organization receive 80% or more of its annual gross revenue from federal awards during the preceding fiscal year?
Section B – Certification About Amount of Annual Gross from Federal Awards Did your organization receive $25 million or more in annual gross revenues from federal awards in the preceding fiscal year?
If your answer is Yes to both sections A and B, you must answer section C.
If your answer is No to either sections A or B, skip section C and continue to section D.
Section C – Certification Regarding Public Access to Compensation Information Does the public have access to information about the highly compensated officers or senior executives in your business or organization, including parent organization, all branches and all affiliates worldwide, through periodic reports filed under Section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or Section 6104 of the Internal Revenue Code of 1986?
If no, provide the names and total compensation of the top five highly compensated officers and senior executives.
Name of Officer or Senior Executive Total Compensation 1.
2.
3.
4.
5.
Section D – Signatures As the duly authorized representative (signer) of the contractor, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge.
10.0.2.20120224.1.869952.867557 Texas Health and Human Services Form 8040, FFATA Federal Awards Certification
| Yes, the public does have access to information about the highly compensated officers or senior executives in your business or organization, including parent organization, all branches and all affiliates worldwide, through periodic reports filed under Section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or Section 6104 of the Internal Revenue Code of 1986.: |
| No, the public does not have access to information about the highly compensated officers or senior executives in your business or organization, including parent organization, all branches and all affiliates worldwide, through periodic reports filed under Section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or Section 6104 of the Internal Revenue Code of 1986.: |
| Name of Officer or Senior Executive: |
| Total Compensation: |
| Signature of Authorized Representative: |
| Date of Signature: |
| Legal Name of Contractor: |
| Title of Authorized Representative: |
| Unique Entity Identifier: |
| Applicable HHSC Contract Number(s): |
File details come from the government source that posted it. Updated .