Risk Assessment Form.doc

PROSPECTIVE AWARDEE’S PRE-AWARD RISK ASSESSMENT

In accordance with Section 200.205 of 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, SSA will conduct a financial risk assessment of prospective grantees before making an award.

In evaluating risks posed by an applicant, SSA will use a risk-based approach and will consider the following:

· Financial stability

· Quality of management systems and the ability to meet the management standards prescribed in 2 CFR 200

· History of performance

· Prior OMB Circular A-133 Audits (if applicable)

Please provide the answers to the questions below as well as any additional requested documentation with your Grant application.

1. If you are a non-profit applicant, please provide the following:

a. When was your organization founded/incorporated (month/day/year)?

b. What is your fiscal year end (month/day/year)?

c. Please provide the names and titles for your Principal Officers?

d. What is the current number of employees (full-time and part-time)?

2. Has an annual audit in accordance with the Single Audit Act and OMB Circular A-133 ever been performed on your organization? If so, what was the last fiscal year that was audited in accordance with the Single Audit Act and OMB Circular A-133?

3. If an OMB Circular A-133 audit was not performed on your organization for the last completed fiscal year, did an independent Certified Public Account (CPA) examine your financial statements? If so, please submit a copy of their latest report and any management letters issued. If an independent CPA was engaged to perform a review but no report was issued, please provide details and an explanation.

4. Do you currently have any Federal grant awards? If yes, please identify the total dollar amount of the grant, federal agency that awarded you the grant, project period of the grant, and the name and contact information for the grant management officer.

5. If you currently have Federal grants has any of them been identified by the Federal Awarding Agency as a High Risk grant? If so, please explain.

6. Is your accounting system in accordance with generally accepted accounting principles? If no, please explain.

7. Is your accounting system currently in full operations? If not, please describe the portions that are (a) in full operation, (b) set up, but not yet in operation, (c) anticipated, or (d) nonexistent.

8. Can the accounting system adequately identify and accumulate the receipt and expenditure of funds by federal grant? If no, please explain.

9. Are documents maintained to support expenditures of funds under a federal grant? If no, please explain.

10. Are timekeeping/distribution records maintained for employees that accurately reflect the work performed so his/her effort can be specifically identified to a particular cost objective? If no, please explain

11. If your organization proposes an indirect cost rate, does the accounting system provide for the segregation of direct costs from indirect costs? If no, please explain.

12. Are internal controls in place to provide reasonable assurance regarding the achievement of objectives in effectiveness and efficiency of operations, reliable financial reporting, and compliance with laws, regulations and policies?

13. Do you have written procedures for determining the allowability of costs in accordance with 2 CFR 200’s Subpart E-Cost Principles? If no, please explain.

14. If Federal grant/contract funds are commingled with organization funds, can the Federal grant funds and related costs and expenses be readily identified? If no, please explain.