Form 1 Financial Management Survey

6

Financial Management Survey, OMB No. 3045-0102

_{Financial Management Survey}

This survey is intended to collect information about the capacity of organizations to manage federal grant funds. Information from the report will be used to assess an organization’s structure and capacity-building needs and identify any appropriate technical assistance and/or resources to strengthen operations. Completion of this report is required, but is independent from the competitive grant process. Responding organizations are advised to make sure that the person or persons completing this form are those responsible for and knowledgeable of the organization’s financial management functions.

_{Please complete all items on this report.}

Organization Name:

EIN: DUNS Number^:

I. Documents, policies and procedures

Instructions for Part I:

• Provide copies of the most recent versions of the requested documents; check boxes if documents are attached.

• If any listed documents are not available please explain; attach additional sheets if necessary.

• Note, some additional documents are identified and requested in other parts of this survey.

1. Public Disclosure Documents

	IRS Determination letter, and any amendments, reflecting approval or denial of tax-exempt status
	Internal Revenue Service Form 990 "Return of Organization Exempt from Income Tax" including all applicable schedules and attachments; if Form 990 filing can be downloaded, provide the website address: ____________________________________________________________________________________
	Schedule of federal awards from IRS Form 990 (if not included above)
	Audited financial statements including auditor's Management Letter (A-133 or other audits if not subject to OBM Circular A-133)
	List of federal grants, contracts, and subgrants/sub-contracts using federal funds awarded to the organization in the last two years including the contract numbers, amounts and awarding agencies

2. Governance

	Articles of Incorporation and By-Laws
	Roster(s) of the Board of Directors, including professional titles, officers and committee membership
	Organizational Chart identifying key staff by title

3. Organizational Policies and Procedures

The list of policies below is designed to identify some of the most critical policies for administration of a federal grant. Your organization may not yet have these and other appropriate policies in place if you are a first-time recipient of federal funds. You will be required to have a full complement of financial, programmatic, and administrative polices as well as internal controls in place, as applicable, within 60 days of receiving any grant award from the Corporation.

Please indicate whether the organization has written policies and procedures in the following areas. If yes, attach the document and report the date it was implemented or most recently updated.

Availability				Item	As of Date
	Yes		No	Table of Contents for Personnel/Employee Handbook/Manual	_____________
	Yes		No	Table of Contents for Financial/Internal Controls Policy Manual	_____________
	Yes		No	Delegations of Authority	_____________
	Yes		No	Timekeeping Guide or Policy	_____________
	Yes		No	Travel Guide or Policy	_____________
	Yes		No	Procurement Guide or Policy	_____________
	Yes		No	Standards for Use of Federal Funds Policy	_____________
	Yes		No	Staff Code of Conduct / Statement of Ethics	_____________
	Yes		No	Document Retention Policy	_____________

II. General Information

1. What year was the organization established? _________________________________

2. What year did the organization receive its first federal grant or contact? _____________________

3. How many employees work for the organization (in full-time equivalents)?

	Fewer than 10		10-49		50-99
	100-249		250-500		> 500

3. _{What was the organization's total budget for the last completed fiscal year?}

	$0 - $499,000		$500,000 - $999,999		$1 M - $4,999,999
	$5 M - $9,999,999		$10 M - $24,999,999		$25 M or more

3. What percentage of the total budget for the last completed fiscal year came from federal and state grants and contracts?

	0 – 10%		11 – 20%		21 – 30%
	31 – 40%		41 – 50%		51 - 60%
	61 – 70%		71 – 80%		81% or more

III. Financial Management

3. Indicate whether the Board has the following committees, and whether they are permanent (per By-Laws) or ad-hoc.

	Executive Committee		Permanent		Ad-Hoc
	Finance Committee		Permanent		Ad-Hoc
	Audit Committee		Permanent		Ad-Hoc
	Other – Please Specify: ________________________ ________________________ ________________________		Permanent Permanent Permanent		Ad-Hoc Ad-Hoc Ad-Hoc

3. Do any paid employees serve as voting members of the Board of Directors?

Yes

No

3. Do position descriptions exist for key financial management positions?

Yes

No

3. Describe the background education, and years of experience in financial management, for key staff identified below. Also, provide copies of their position descriptions, indicating if attached Yes or No:

Position	Education	Years Experience	Position Description Attached?
8a. Chief Financial Officer or equivalent	_____________________	________________	_________
8b. Bookkeeper / Accountant or equivalent	_____________________	________________	_________
8c. Other key financial staff positions, list below:
____________________________	_____________________	________________	_________
____________________________	_____________________	________________	_________
____________________________	_____________________	________________	_________

3. Who is responsible for approving / accepting the annual independent audit? (Check all that apply)

	Audit Committee		Board Chair		Board of Directors		Chief Executive
	Chief Financial Officer		Finance Committee		Other (Specify):

3. How often are financial reports prepared for executive staff?

Quarterly

Monthly

Weekly

Daily

Other specify: ____________________

3. How often does the Board of Directors or a committee of the Board compare financial reports or other updates against budget projections and/or cash flow projections?

Quarterly

Monthly

Weekly

Daily

Other specify: ____________________

3. Did the Board of Directors vote to adopt the current annual operating budget?

Yes

No

3. Does the board approve an annual fundraising plan?

Yes

No

IV. Financial Controls

3. Does the organization maintain a chart of accounts?

	Yes		No
	Copy of chart of accounts is attached.

Does the organization perform job cost center accounting?

Yes

No

(A job cost accounting system allows you to record budgets, revenues and expenses by cost centers, jobs, grants, and activities)

3. How often do you post transactions to the general ledger?

Daily

Weekly

Monthly

Annually

Other: _______________

3. Are at least two original signatures required on checks written above a dollar threshold (determined by the organization) from any bank account(s) that are used for the receipt and/or disbursement of organizational funds, including those from federal sources?

Yes

No

If yes, what is the dollar threshold? ____________________________________

Are different staff members responsible for the distinct functions of reconciling cash receipts and cash disbursement?		Yes		No
Do distinct staff members authorize and maintain records of financial transactions?		Yes		No
Does the organization use an automated payroll system?		Yes		No
Does the organization follow a review and approval procedure when disbursing payroll?		Yes		No
Is there a maximum amount that can be withdrawn from petty cash?		Yes		No
Are receipts required for petty cash expenditures?		Yes		No

3. Is Board approval required for any of the following financial transactions?

Opening / Closing Bank Accounts		Yes		No	Buying / Selling Property		Yes		No
Opening Lines of Credit		Yes		No	Financial Investment / Divestment		Yes		No
Assigning Credit Cards		Yes		No	Other specify: ________________________________

3. Yes

   No

   Has the organization issued any loans to an employee or officer of the organization, or forgiven or written-off any loans or debts of any type in the past 12 months?

3. Who is authorized to write-off any debt owed the organization as a bad debt?

	Accountant		Chief Financial Officer		CEO/Executive Director		Board Committee
	Board Chair		Other, specify: ______________________________________________________

3. Yes

   No

   How often does the organization experience cash flow deficits?

Weekly

Monthly

Quarterly

Annually

None in last 2 years

VI. Organizational Policies and Procedures

3. How are the organization’s policies and procedures shared with employees? (Check all that apply)

	eMail		Memorandum		Employee Handbook		Management Informs
	Orientation and training		Intranet		Staff meeting		Other: ____________
	There is no existing procedure

3. When has training for relevant staff been provided in the following areas?

Subject Area		Within 1 year	Within 2 years	Within 3 years	> 3 years ago	Never
	Financial/Accounting
	Fundraising
	Personnel/HR Issues
	Risk Management
	Other: _______________
	Other: _______________
	Other: _______________

3. _{What would increase the financial capacity and expertise of the organization? (Check all that apply)}

	Additional Staff		Computerized Accounting System		Financial Training		Professional Certifications
	Other, specify:______________________________________________________________

3. _{What training and technical assistance do you believe would benefit your organization and enhance its ability to administer federal grant awards? (Check all that apply)}

	OMB Circulars and Corporation Regulations
	Basic federal grant administration requirements
	Programmatic performance metrics and management
	Budget development and execution
	Federal cash management
	Documenting in-kind and matching contributions
	Avoiding common audit findings

The completed Financial Management Survey, with attachments, is to be submitted in hard copy form to the following address:

Attention: Kim Hammonds

Office of Grants Management

8^th Floor, OGM

Corporation for National and Community Service

1201 New York Avenue, NW

Washington, DC 20525

You may contact Ms. Hammons on 202-606-6968 if you have any questions.

Preparer’s Comments/Explanations: Please present any clarifications or similar remarks/information here:

The total number of attachments is ______. Please number attachments in sequence.

Preparer Certification

By my signature below, I certify that the above information is complete and correct to the best of my knowledge and ability.

Signature of Preparer:
Name of Preparer:		Date:
title of Preparer:
Telephone:
e-Mail:
Identify anyone else involved in the preparation of this survey by name and position title:

Corporation receipt record:

Received on: __________________

Date

Received/Logged by: ________________________________________________________________

Name/Title of Corporation Staff