Financial Management Survey.doc

DEPARTMENT OF STATE

FINANCIAL MANAGEMENT SURVEY

Legal Name of Organization:

Address:

City/State/Zip Code:

Please answer every question, attaching materials & providing comments/explanations.

A.

GENERAL INFORMATION

1. Have you read and are familiar with the applicable Office of Management and Budget (OMB Uniform Guidance Requirements?

( YES ( NO

2. Has your organization received a Federal grant award or cost-type contract award in the last 2 years?

( YES ( NO

If yes, what is your Federal cognizant/oversight agency?

Agency:___________________________________________________Name of Contact:___________________________________________________

Telephone:_________________________________________________ Please attach a schedule showing the total Federal dollars awarded to your organization by granting agency for the two most recently completed fiscal years.

3. Does your organization have a Federally approved Indirect Cost Rate?

If yes, what type:

( Provisional

( Final

( Predetermined

Please attach a copy

If no, When do you plan to establish a rate in accordance with Federal cost principles requirements?

4. Has your organization ever received Department of State funding?

If yes, please specify the award number[s]:

5. Indicate whether your organization is:

( a non-profit educational institution

( a non-profit organization

( a Tribe

( a Territory

( other, please specify _______________________________

6. Has your organization been audited by a Certified Public Accounting firm within the past two years?

If yes, please attach copy.

7. Has your organization completed a recent OMB A-133 audit?

If yes, please attach most recent copy.

If no, is one currently underway or scheduled?

( YES ( NO

Give completion date where applicable. _______________________

8. Has your organization been granted tax-exempt status by the IRS?

( YES ( NO ( N/A

9. Under which section of the IRS Code?

( 501(c)(3)

( 501(c)(4)

( 501(c)(5)

( 501(c)(6)

(other, specify _______________________________

Please attach a copy of the most recently filed IRS Form 990.

10. Does your organization have established policies relating to salary scales, fringe benefits, travel reimbursement and personnel policies?

B.

FUNDS MANAGEMENT

1. Are you using a job cost system?

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

( Manual

( Automated

( Combination

3. How frequently do you post to the general ledger?

( daily ( weekly ( monthly ( other

4. Does the accounting system completely and accurately track the receipt and disbursement of funds by each grant or funding source?

( YES ( NO

5. Are common or indirect costs accumulated into cost pools for allocation to projects, contracts and grants?

( YES ( NO

6. Are the following books of account maintained?

General Ledger

Cash Receipts Journal

( YES ( NO

Cash Disbursements Journal

Payroll Journal

Income (Sales) Journal

Purchase Journal

General Journal

Other

Describe: _________________________

7. Does the accounting system provide for the recording of actual grant/contract costs according to categories of your approved budget[s], and provide for current and complete disclosure?

8. Are time and activity distribution records maintained by funding source and project for each employee to account for total hours [100%] devoted to your organization?

9. Is your organization familiar with Federal cost principles?

10. Is your organization familiar with procedures for the determination and allowance of costs in connection with Federal grants and contracts?

( YES ( NO

11. If a first time recipient whose accounting system has not been subjected to a re-award or final audit under OMB Circular 1-133 Audits of State, Local Governments, and Non-Profit Organizations, would you agree to maintain a separate bank account in accordance with OMB Circular A-110 Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations? (NOTE: Once your system has been audited, a separate account may no longer be required)

( YES ( NO

C.

INTERNAL CONTROLS

1. Are the duties of the bookkeeper/record keeper separate from cash functions (receipt or payment or cash)?

2. Are checks signed by individual[s] whose duties exclude recording cash received, approving vouchers for payment and the preparation of payroll?

3. Are purchase approval methods documented and communicated?

4. Are accounting entries supported by appropriate documentation?

5. Are cash, cost sharing or in-kind matching funds supported by appropriate documentation?

( YES ( NO

6. Are employee time sheets supported by appropriately signed documentation?

( YES ( NO

7. Are employees who handle funds bonded against loss by reasons of fraud or dishonesty?

( YES ( NO

8. Are there procedures documented for complying with the applicable cost principles and the conditions of the award?

COMMENTS/EXPLANATIONS:

The total number of attachments is:_______ including:

Audit[s]

Schedule

IRS Form 990

Attach numbered sheets as necessary.

Certification

The information disclosed in the attached financial management survey is true and accurate to the best of my knowledge and belief.

Signature of Preparer:

Name of Preparer:

Date:

title of Preparer:

Telephone:

Fax:

e-Mail:

FOR INTERNAL USE ONLY AT Department of State

Reviewed by: ____________________________________________________________________

Date: __________________________________________________________________________

Comments: