OFR Risk Questionnaire.xlsx
XLSX spreadsheet 16 KB Posted
- Opportunity number
- CDC-RFA-OT18-1802
- Issued by
-
Department of Health and Human Services
About this file
OFR Risk Assessement
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Other files
| File | Type | Posted |
|---|---|---|
| CDC-RFA OT18-1802 FAQs.pdf | ||
| CDC-RFA-OT18-1802-Target-Population.pdf | ||
| OT18-1802 Pre-application script_FINAL.pdf | ||
| OT18-1802 NOFO_Pre Application Presentation_FINAL.pptx | PPTX presentation | |
| OFR Risk Questionnaire.xlsx | XLSX spreadsheet | |
| CDC-RFA-OT18-1802.pdf | ||
| CDC-RFA-OT18-1802 Amend 2.pdf | ||
| CDC-RFA-OT18-1802 Amend 1.pdf | ||
| OFR Risk Questionnaire.xlsx | XLSX spreadsheet | |
| CDC-RFA-OT18-1802.pdf | ||
| CDC-RFA-OT18-1802 Amend 1.pdf | ||
| CDC-RFA-OT18-1802.pdf | ||
| oppCDC-RFA-OT18-1802-cfda93.421-cidCDC-RFA-OT18-1802-instructions.pdf |
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Text version
Risk Questionnaire
| Form Approved |
| OMB Control Number 0920-1132 |
| Expiration Date: 8/31/2019 |
Attachment G - PERFORMANCE PROGRESS and MONITORING REPORT - OFR Risk Questionnaire
| Risk Questionnaire | |
| Instructions: | Prior to making an award, the Centers for Disease Control (CDC) evaluates the degree of risk posed by an applicant. |
In filling out the Risk Questionnaire, each question should be answered as completely as possible, using extra pages if necessary. Please return your completed questionnaire to [Name of Contact].
| General Information | |||
| Legal Name of Organization | |||
| In which country (or countries) does your organization propose to operate for this NOFO- <insert #>? Please list all separated by commas. | |||
| In which country is the headquarters or general office of your organization located? | |||
| Please identify what type of organization you are (non-profit, for-profit, educational institution, other)? | |||
| Is your organization incorporated or legally registered? | If not, please explain: | ||
| Operational Risk | |||
| Personnel | Does your organization have a President/Director/Chief Executive Officer and Chief Financial Officer? | If not, please explain: | |
| Does your organization have written human resource (HR) policies and procedures? | If not, please explain: | ||
| List the number of employees within your organization | Full Time Employees: | ||
| Part-time Employees: | |||
| Volunteers: | |||
| Programmatic Performance | Has your organization managed U.S. Government grants or cooperative agreements within the last 36 months? | ||
| Financial Risk | |||
| Accounting System | Does your organization have written accounting policies and procedures? | Explanation: | |
| Can your accounting records separate the receipts and payments of a federal grant from the receipts and payments of your organization's other activities? | |||
| Can your accounting records summarize expenditures from a federal grant according to different budget categories such as salaries, rent, supplies and equipment? | |||
| Internal Controls | Does your organization have systems, policies, and procedures for tracking and approving hours worked by employees, contractors, and volunteers? | ||
| Does your organization have internal controls and anti-corruption ethics codes that are emphasized by leadership? | |||
| Does your organization have written project management policies, procedures, and systems? | If no, please provide an explanation: | ||
| Is your organization familiar with U.S. government regulations concerning costs which can be charged to U.S. grants (Title 2, U.S. Code of Federal Regulations, Part 200, Subpart E)? | |||
| Cash Management | Does your organization have a bank account registered in its name and that is capable of segregating grant funds from other funds? | If not, please explain how you plan to manage funds from a potential award? | |
| Going Concern | What percent of your organization's capital is from federal funding? (percentage = total federal funding in previous FY/ organization's annual gross revenue in previous FY) | ||
| What is the dollar amount of your total current assets? (i.e. cash and other assets that are expected to be converted to cash within the next twelve months) | |||
| What is the dollar amount of your total current liabilities? (i.e. amounts due to be paid to creditors within the next twelve months) | |||
| What is the dollar amount of your total debt? | |||
| What is the dollar amount of your total assets? (e.g. cash, fixed assets, accounts receivable, etc.) |
| Compliance Risk | |||
| Audit | Does your organization have regular independent audits that you contract and pay for? | ||
| If yes, who performs the audit? | |||
| What was the date of the most recent audit and what was the result? | Date: | Opinion: |
Backend
| Non-profit organization, | ||
| For-profit enterprise | ||
| Government agency | ||
| Education Institution | ||
| Other | ||
| Received CDC grant within the last 3 years | ||
| Received federal grant but not from CDC within the last 3 years | ||
| No federal grants in the last 3 years | ||
| Monthly | Quarterly | Quarterly |
| Quarterly | Yearly | Yearly |
| Annually | Every 2 years | Other |
| Not Prepared | Other | |
| Yes, enclosed | ||
| No, explanation provided | ||
| Yes | ||
| No | ||
| Organization has documented and uniformly enforced systems, policies and procedures for tracking and approving hours worked by employees, contractors and volunteers | ||
| Organization has systems, policies and procedures for tracking and approving hours worked by employees, contractors and volunteers but these are not comprehensive, well documented or uniformly applied | ||
| Organization does not have systems, policies or procedures for tracking and approving hours worked by employees, contractors and volunteers | ||
| Organization has established internal control system and an anti-corruption ethics code that is emphasized by leadership | ||
| Organization has written policies regarding internal control and anti-corruptions ethics | ||
| Organization does not have any internal control policies or procedures and leadership has not discussed these topics |
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