National Historical Publications and
Records Commission – National Archives
ACCOUNTING SYSTEM
AND FINANCIAL CAPABILITY QUESTIONNAIRE
If
you are a recipient of a federal grant, you must have adequate
financial controls. Adequate accounting systems should meet the
following criteria:
(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.
APPLICANT ORGANIZATIONAL INFORMATION
Name
of Organization and Address:
NHPRC
Application No:
Authorized
Representative’s Name and Title:
Phone:
- -
ext
Fax:
- -
Email:
Year
Established (yyyy):
Employer
Identification Number (EIN) (example
XX-XXXXXXX):
-
DUNS
Number
(example
XXX-XX-XXXX):
- -
Type
of Organization:
Approximate
Number of Employees:
Full
Time (Paid):
Full
Time (Volunteer):
Part
Time (Paid):
Part
Time (Volunteer):
Federal AuDIT DATA
Have
you been audited by a Federal agency?:
Yes No
If
yes, please indicate the type:
OMB A-133 Single Audit (required of institutions that received
more that $500,000 in federal grants)
Incurred Cost Accounting System
Timekeeping
Date
of Last Federal Audit/Review (m/d/yyyy):
Audit
Agency/Firm:
If
Findings Reports, Explain:
FINANCIAL STATEMENT AUDIT DATA
Date
of Last Financial Statement Audit (m/d/yyyy):
Fiscal
Period Audited:
Audit
Firm:
Auditor’s
Opinion on Financial Statement Qualified:
Yes
No
If
Qualified Opinion, State Reason:
If
you have not had an audit completed in the last two years,
please submit a copy of your most recent 990 tax form. If you
do not have a 990 tax form, please explain:
ACCOUNTING SYSTEM
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?:
Yes No
If
yes, provide name and address of Agency performing review:
Attach
a copy of the latest review and any subsequent correspondence,
clearance documents, etc.
Which
of the following best describes the accounting system:
Manual Automated
Combination
Does
the accounting system identify the receipt and expenditure of
program funds separately for each contract/grant?
Yes No
Not Sure
Does
the accounting system provide for the recording of expenditures
for each grant/contract by the component project and budget cost
categories shown in the approved budget?
Yes No
Not Sure
Does
the accounting system provide for the recording of cost sharing
for each project, and ensure that documentation is available to
support recorded cost sharing?
Yes No
Not Sure
Are
time distribution records maintained for an employee when
his/her effort can be specifically identified to a particular
cost objective? (please
attach sample time sheet and procedures for allocating salary
and wage charges to Federal awards)
Yes No
Not Sure
Does
the accounting/financial system include budgetary controls to
preclude incurring obligations in excess of total funds
available for a grant?
Yes No
Not Sure
Does
the accounting/financial system include budgetary controls to
preclude incurring obligations in excess of total funds
available for a budget cost category (e.g. Personnel, Travel,
etc)?
Yes No
Not Sure
Is
the firm 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
contracts/grants?
Yes No
Not Sure
FUNDS Management
Is
a separate bank account maintained for Federal grant funds?
Yes No
If
a separate back account is not maintained, can the Federal grant
funds and related expenses be readily identified?
Yes No
Financial STATEMENTS
Did
an independent certified public accountant (CPA) ever examine
the financial statements?
Yes No
If
an independent CPA review was performed, please provide this
office a copy of their latest report and any management letters
issued.
Enclosed N/A
If
an independent CPA was engaged to perform a review and no report
was issued, please provide details and an explanation on a
separate sheet.
APPLICANT CERTIFICATION
I
certify that the above information is complete and correct to
the best of my knowledge.
Signature:
Name:
Title:
Paperwork
Reduction Act Public Burden Statement
The information requested on this form is
being collected and used to ensure that recipients of grants from
the National Archive’s National Historical Publication and
Records Commission have the necessary financial and management
controls to manage Federal funds. We estimate the public burden per
response is four hours to read the instructions, gather necessary
data, and complete the information collection. The Paperwork
Reduction Act requires us to notify you that a Federal agency may
not conduct or sponsor and you are not required to respond to a
collection of information unless it displays a currently valid OMB
control number. The OMB control number for this information
collection is 3095-00XX. Send comments regarding the burden
estimate or any other aspect of the collection of information,
including suggestions for reducing this burden, to National Archives
and Records Administration (I-P), Room 4400, 8601 Adelphi Road,
College Park, MD 20740-6001, and to the Office of Management and
Budget, Paperwork Reduction Project (3095-00XX), Washington, DC
20503. DO NOT SEND COMPLETED FORMS TO THESE ADDRESSES. Mail these
forms to:
NHPRC
Room 114
National Archives and Records
Administration
700 Pennsylvania Avenue, NW
Washington, DC 20408-0001
These forms can also be scanned and
emailed to: [email protected], or
faxed to 202-357-5914.
NATIONAL
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AND
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4
of 4 NA
Form 17003 (02-12)