IG_FDR_Request_Form.pdf

Independent Office of Audits and Investigations - Financial Document Review Request Form - Revised 12/2024 1

INSPECTOR GENERAL

Financial Document Review (FDR) Request Form

• To be completed by Local Public Agencies (LPA) - one per contract.

• For new proposed Architectural & Engineering (A&E) consultant LPA contracts of $1 million or greater.

• For amendments, use only when there are additional subconsultants or changes in Indirect Cost Rate (ICR).

Email to:

conformance.review@dot.ca.gov California State Department of Transportation Independent Office of Audits and Investigations Attention: Financial Document Review Manager

Date:

Federal/State Project Number:

Check one: New Contract Amendment Other

A&E Contract Number: Total Contract or Amended Amount of:

Prime Consultant Full Legal Name:

Project Description:

List prime consultant and all Safe Harbor Rate (SHR) applicants below. In addition, list all subconsultants with estimated contract costs of $500,000 and above on this contract. Prime consultants must have a CPA audited ICR report and schedule. (Add pages if necessary.)

Consultant’s Legal Name Estimated Participation Amount Category CT ID# (if available)

I verify we received financial documents from the prime and subconsultants based on the requirements specified in this form’s checklist seen on following page.

Signature:

Name (Print): Title:

Name of Local Agency and Department:

Address:

Phone: Email:

mailto:conformance.review%40dot.ca.gov?subject=

Independent Office of Audits and Investigations - Financial Document Review Request Form - Revised 12/2024 2

CHECKLIST

FDR Requirements for A&E Consultant Indirect Cost Rate

• Requirements for total contract amount equal to or greater than $1,000,000.

• Prime and all subconsultant(s) with estimated contract costs of $500,000 and above must provide the documents marked below based on their applicable category.

Instructions

• LPAs are required to complete this form and include all applicable required documents upon submission.

• For financial document packages received between July 1, 2024 through June 30, 2025, the 2023 or newer

ICR must be submitted.

• CT ID#: This is an identification number issued by Caltrans upon review and acceptance of consultant’s

ICR(s) schedule for a specific fiscal year. The CT ID# ICR fiscal year end (FYE) must agree with the period when this form and financial documents are submitted as described above. Consultants with a current CT ID# shall include the CT ID# on page 1 of this form and select N/A as the Category; no additional documents are required at this time.

Please note: Items on this checklist may not be all inclusive. IOAI reserves the right to request additional documents as deemed necessary.

Type of Financial Documents and

Information for ICR FYE Proposed by

Consultant

CATEGORY 1:

Cognizant Approval

Letter from an approved reviewing agency for ICR FYE

Proposed

CATEGORY 2:

Requesting Safe

Harbor Rate

CATEGORY 3:

CPA Audited ICR

Report

CATEGORY 4:

Participation Amount of $500K or Greater and No CPA Report

Certification of Indirect Costs and Financial Management System Form

CPA Audited ICR Report and Schedule (Prime Consultant must have a CPA Audited ICR Schedule)

ICR Schedule with FAR References for Disallowed Costs (a)

Cognizant Approval Letter for the ICR FYE proposed

AASHTO Internal Control Questionnaire Appendix B

(a) See Table 8-1 of the AASHTO Audit Guide for a listing of common unallowable costs.

Post-Closing Trial Balance and Supplemental Reconciliation Schedule (to tie the proposed ICR Schedule to the Trial Balance)

Uncompensated Overtime Adjustments

Executive Compensation Analysis (ECA) of Eligibility of Contract Consultant Certification Safe Harbor Rate:

Management System Costs and Financial

Independent Office of Audits and Investigations - Financial Document Review Request Form - Revised 12/2024 3

Some or all of the documents listed below may be requested:

• Prior Year ICR Schedule

• Related Party Rent Analysis

• Chart of Accounts

• Income Statement

• Vacation/Sick Policy

• Bonus Policy

• Vehicle, Equipment, and Other Direct Costs Schedules

The following documents can be retrieved from https://oig.dot.ca.gov/resources:

• Certification of Indirect Costs and Financial Management System

• AASHTO Internal Control Questionnaire Appendix B

• Safe Harbor Rate – Consultant Certification of Eligibility of Contract Costs and Financial Management

System

Type of Financial Documents and

Information for ICR FYE Proposed by

Consultant

CATEGORY 1:

Cognizant Approval

Letter from an approved reviewing agency for ICR FYE

Proposed

CATEGORY 2:

Requesting Safe

Harbor Rate

CATEGORY 3:

CPA Audited ICR

Report

CATEGORY 4:

Participation Amount of $500K or Greater and No CPA Report https://ig.dot.ca.gov/resources