RFGAAttF - Sample Federal Funding Accountability and Transparency Act (FFATA) Form.doc
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- Attached to
- RFGA S-44300-00010881 for Culturally and Linguistically Specific Behavioral Health Services
- Solicitation number
- S-44300-00010881
- Issued by
- Multnomah County, Oregon
About this file
This is a Federal Funding Accountability and Transparency Act (FFATA) form template from the Oregon Department of Human Services (ODHS) and Oregon Health Authority (OHA). The form is required for federal subawards exceeding $30,000 and must be completed before contract execution. It requires submission of the entity's legal name, SAM.gov Unique Entity Identifier (UEI) number, and business contact information including name, title, date, and complete mailing address with 9-digit ZIP code.
The form requires disclosure of executive compensation information if the company receives 80% or more of its annual gross revenue and $25,000,000 or more from federal contracts and assistance awards, unless this information is already publicly available through SEC or IRS filings. When required, companies must report the names and annual compensation of their five most highly compensated executives. Compensation includes salary, bonuses, stock awards, non-equity incentive earnings, pension value changes, and other compensation as defined in Federal 2 CFR Part 170. Questions about the form can be directed to the FFATA Coordinator at ffata.info@odhsoha.oregon.gov.
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Text version
Federal Funding Accountability and Transparency Act (FFATA)
SUBAWARD REPORTING
This form is required by the Oregon Department of Human Services (ODHS) and the Oregon Health Authority (OHA) to fulfill a federal requirement for contracting under the Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting System (FSRS). FFATA reporting is a requirement for subawards (also known as subrecipients) of federal awards in excess of $30,000. When the funding source for an ODHS or OHA contract or agreement is a federal grant with a subrecipient relationship, the information below is required before execution:
Information to obtain SAM.gov UEI Information to obtain 9-digit ZIP
| Legal entity name: |
| SAM.gov Unique Entity Identifier (UEI) number: (12-digit) |
Business entity contact information: (person completing form)
Name
Title
Date
Mailing Address, City, State
ZIP+4 (9-digit)
Executive compensation information may also be required. To determine this, answer the following:
1. Does your company (1) receive 80% or more of its annual gross revenue and (2) $25,000,000 or more in federal procurement contracts (and subcontracts) and federal financial assistance awards subject to the Transparency Act?
FORMCHECKBOX
Yes
FORMCHECKBOX
No If “yes,” proceed to 2. If “no,” you are not required to supply executive compensation information. Complete the business entity contact information and return form to ODHS/OHA requestor.
2. Does the public have access to information about the compensation of the senior executives through periodic reports filed under section 13(a) or 15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986?
FORMCHECKBOX
Yes
FORMCHECKBOX
No If “yes,” you are not required to supply executive compensation information. Complete the business entity contact information and return form to ODHS/OHA requestor. If “no,” provide the executive compensation information below.
Names and annual compensation amount of five most highly compensated executives:
| 1 |
| $ |
| 2 |
| $ |
| 3 |
| $ |
| 4 |
| $ |
| 5 |
| $ |
RETURN COMPLETED FORM TO:
| ODHS/OHA requestor: |
| Address/city/state/zip: |
| Phone: |
| Email: |
Background on FFATA requirements
The Federal Funding Accountability and Transparency Act (FFATA) was signed on September 26, 2006. The intent is to empower every American with the ability to hold the government accountable for each spending decision. The end result is to reduce wasteful spending in the government. The FFATA legislation requires information on federal awards (federal financial assistance and expenditures) be made available to the public via a single, searchable website, which is www.USASpending.gov.
Prime contractors awarded a federal contract or order that is subject to Federal Acquisition Regulation clause 52.204-10 (Reporting Executive Compensation and First-Tier Subcontract Awards) are required to file a FFATA subaward report by the end of the month following the month in which the prime contractor awards any subcontract greater than $30,000.
Definition of compensation
Unless the contractor is exempt, FFATA requires you to report total compensation for each of your five most highly compensated executives for the preceding completed year. Total compensation means the cash and non-cash dollar value earned by the executive during the recipient's or subrecipient's preceding fiscal year and includes the following: salary and bonus; awards of stock, stock options, and stock appropriation rights; earnings for services under non-equity incentive plans; change in pension value; above-market earnings on deferred compensation which is not tax-qualified; and other compensation as defined in Federal 2 CFR Part 170, Section 170.330(b)(5)(vi).
Unique Entity Identifier (UEI) information
· Locating your UEI on SAM.gov
· For additional information and assistance with your UEI, visit https://sam.gov/content/home Contact information For questions and additional information, contact the FFATA Coordinator at ffata.info@odhsoha.oregon.gov.
MSC 0513 (8/11 Rev.)
MSC 0513 (7/22 Rev.)
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