L17AS00157 MUST Financial Capability Questionnaire.xlsx

XLSX spreadsheet 27 KB Posted Jun 12, 2017

Attached to: BLM CA Seed Strategy Action Item 2.4.2
Opportunity number: L17AS00157
Issued by: Department of the Interior

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L17AS00157 MUST Financial Capability Questionnaire

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File	Type	Posted
L17AS00157 MUST Tool Recipient Evaluation Question.docx	DOCX document	Jun 12, 2017
L17AS00157 BLM CA Seed Strategy Action Item 2.4.2.docx	DOCX document	Jun 12, 2017
oppL17AS00157-cfda15.231-instructions.docx	DOCX document	Jun 12, 2017
L17AS00157 MUST Tool Recipient Evaluation Question.docx	DOCX document	Jun 12, 2017
L17AS00157 BLM CA Seed Strategy Action Item 2.4.2.docx	DOCX document	Jun 12, 2017
L17AS00157 MUST Financial Capability Questionnaire.xlsx	XLSX spreadsheet	Jun 12, 2017
oppL17AS00157-cfda15.231.pdf	PDF	Jun 12, 2017

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Financial Capability Questionna

DOI Financial Assistance - FINANCIAL CAPABILITY QUESTIONNAIRE

Use this form if a recipient is not subject to the Single Audit and has not undergone an independent audit.

NOTE TO REVIEWERS: This is a standard form that the Department of Agriculture uses for their awards. The intent is to customize this form for DOI use. PAM is pursuing the creation of this as a standard form with DOI's Record Office.

Adequate accounting systems should meet the following criteria as outlined in the Office of Management and Budget’s (OMB) Circular of Uniform Administrative Requirements, Cost Principles, and Audit Requirements found in 2 CFR Part 200, as implemented by the Financial Assistance Interior Regulation found in 2 CFR Part 1403.

(1) Accounting records should provide information needed to adequately identify the receipt of funds under each grant awarded and the expenditure of funds for each grant.

(2) Entries in accounting records should refer to subsidiary records and/or documentation which support the entry and which can be readily located.

(3) The accounting system should provide accurate and current financial reporting information.

(4) The accounting system should be integrated with an adequate system of internal controls to safeguard the funds and assets covered, check the accuracy and reliability of accounting data, promote operational efficiency, and encourage adherence to prescribed management policies.

Instructions to use this Template

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	SECTION 1 – APPLICANT ORGANIZATIONAL INFORMATION
	1. Name of Organization and Address:
	2. Authorized Representative’s Name and Title:
	3. Phone: (and extension)			4. Fax:
	5. Email:			6. Year Established:
	7. Employer Identification Number (EIN):			8. DUNS Number:
	9. Type of Organization:
	10. Approximate Number of Employees:
Full Time (Paid):		Full Time (Volunteer):	Part Time (Paid):		Part Time (Volunteer):

SECTION 2 – ACCOUNTING SYSTEM
	Yes	No
11. Has any Government Agency rendered an official written opinion concerning the adequacy of the accounting system for the collection, identification and allocation of costs under Federal contracts/grants?	[ ]	[ ]
12. If yes, provide name and address of Agency performing review: (Attach a copy of the latest review and any subsequent correspondence, clearance documents, etc.)
	Manual	Automated	Combination
13. Which of the following best describes your accounting system:	[ ]	[ ]	[ ]
	Yes	No	Not Sure
14. Does the accounting system identify the receipt and expenditure of program funds separately for each grant?	[ ]	[ ]	[ ]
15. Does the accounting system provide for the recording of expenditures for each grant/contract by budget cost categories shown in the approved budget?	[ ]	[ ]	[ ]
16. Does the accounting system provide for the recording of cost sharing or match for each grant? Can you ensure that documentation is available to support recorded match or cost share?	[ ]	[ ]	[ ]
17. Are time distribution records maintained for each employee that specifically identify effort charged to a particular grant or cost objective?	[ ]	[ ]	[ ]
18. Does the accounting/financial system include budgetary controls to preclude incurring obligations or costs in excess of total funds available for a grant?	[ ]	[ ]	[ ]
19. Does the accounting/financial system include budgetary controls to preclude incurring obligations or costs in excess of total funds available for a budget cost category (e.g. Personnel, Travel, etc.)?	[ ]	[ ]	[ ]
20. Is your organization generally familiar with the existing regulation and guidelines containing the Cost Principles and procedures for the determination and allowance of costs in connection with Federal grants?	[ ]	[ ]	[ ]
21. Is a separate bank account maintained for Federal grant funds?	[ ]	[ ]	[ ]
22. If a separate bank account is not maintained, can the Federal grant funds and related expenses be readily identified?	[ ]	[ ]	[ ]

SECTION 3 – PROPERTY STANDARDS, PROCUREMENT STANDARDS, AND TRAVEL POLICIES
PROPERTY STANDARDS	Yes	No	Not Sure
23. Does your property management system(s) provide for maintaining: (1) a description of the equipment; (2) an identification number; (3) source of the property, including the award number; (4) where title vests; (5) acquisition date; (6) federal share of property cost; (7) location and condition of the property; (8) acquisition cost; & (9) ultimate disposition information?	[ ]	[ ]	[ ]
24. Does your property management system(s) provide for a physical inventory and reconciliation of property at least every two years?	[ ]	[ ]	[ ]
25. Does your property management system(s) provide controls to insure safeguards against loss, damage or theft of the property?	[ ]	[ ]	[ ]
PROCUREMENT STANDARDS	Yes	No	Not Sure
26. Does your organization maintain written procurement procedures which (1) avoid unnecessary purchases; (2) provide an analysis of lease and purchase alternatives; and (3) provide a process for soliciting goods and services?	[ ]	[ ]	[ ]
27. Does your procurement system provide for the conduct to ensure selection on a competitive basis and documentation of cost or price analysis for each procurement action?	[ ]	[ ]	[ ]
28. Does your procurement system include provisions for checking the “Excluded Parties List” system for suspended or debarred sub-grantees and contractors, prior to award? www.sam.gov	[ ]	[ ]	[ ]
TRAVEL POLICY	Yes	No	Not Sure
29. Does your organization maintain a standard travel policy or, if nopolicy exists, does your organization adhere to rates and amounts established under 5 U.S.C. 5701–11, (‘‘Travel and Subsistence Expenses; Mileage Allowances’’), and policies under the Federal Acquisition Regulations at 48 CFR 31.205–46(a)?	[ ]	[ ]	[ ]
SUBRECIPIENT MANAGEMENT	Yes	No	Not Sure
30. (For Pass-through entities only). Does your organization have controls in place to monitor activities of subrecipients, as necessary, to ensure that Federal awards are used for authorized purposes in compliance with laws, regulations, and the provisions of the award and that performance goals are achieved.	[ ]	[ ]	[ ]
INDIRECT COSTS	Yes	No	Not Sure
31A. We are a U.S. state or local government entity receiving more than $35 million in direct Federal funding each year with an approved indirect cost rate.	[ ]	[ ]	[ ]
31B. We are a U.S. state or local government entity receiving less than $35 million in direct Federal funding each year with an established indirect cost rate.	[ ]	[ ]	[ ]
31C. We are a non-governmental entity that has previously negotiated an indirect cost rate or has a current approved indirect cost rate.	[ ]	[ ]	[ ]
31D. We are an entity that has never submitted an indirect cost rate proposal to our cognizant agency. In the event an award is made, we will submit a rate proposal to our cognizant agency.	[ ]	[ ]	[ ]
31E. We are an entity that has never submitted an indirect cost rate proposal to our cognizant agency. In the event an award is made, we agree as a condition of award to charge the 10% de minimis indirect cost rate.	[ ]	[ ]	[ ]
31D. We are an entity that charges all costs directly.	[ ]	[ ]	[ ]
32. If my organization chooses to charge indirect costs to the Federal award or use indirect costs as a match, you understand that you must prepare an indirect cost rate proposal and submit it to your cognizant Federal agency for approval. Alternatively, you may use a de minimus rate of 10% of modified total direct costs (MTDC).

STANDARDS FOR FINANCIAL MANAGEMENT SYSTEMS and APPLICANT CERTIFICATION
I certify that the above information is complete and correct to the best of my knowledge. The signature provided below serves as the digital signature for this document. By replacing "[Block 1]" with a name and "[Block 2]" with a date, the signer approves the information provided in this document. (Use the following method to check signature authentication via revision history: on keyboard, press and hold Ctrl+Alt+Shift+H)
Name:
Title:
Signature	[Block 1]
Date	[Block 2]
Nov-16

https://drive.google.com/a/ios.doi.gov/previewtemplate?id=1v_AcjTnF9Y9_1oTCozG3RLNgjkRd1jengzm5BHCuKr0&mode=domain Retired Conditions

Retired conditions
Date Retired	Condition Reference	Description
1/20/15	Condition 1a	Where an individual is receiving a Federal payment by check prior to May 1, 2011. In such cases, the individual may continue to receive those payments by check through February 28, 2013;
1/21/15	Condition 1b	Where an individual files a claim for a Federal payment prior to May 1, 2011, and requests payment by check at the time he or she files the claim. In such cases, the individual may receive those payments by check through February 28, 2013;
1/22/15	Condition 1c	Where an individual was born prior to May 1, 1921, and is receiving payment by check on March, 2013;

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