Form 1 Financial Management Survey

Appendix to OGM-2010-03, OMB No. 3045-0102, Expires ##/##/####

Financial Management Survey
This survey is intended to collect information about the capacity of organizations to manage federal grant funds. Information from the
survey 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 survey is required, but is independent from the competitive grant process.
Responding organizations are advised to ensure that the person or persons completing this form are those responsible for, and with
sufficient knowledge 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.
A. 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:
____________________________________________________________________________________
Audited financial statements including auditor's Management Letter (A-133 audit, or other audits if not subject to
OMB 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
B. 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
Public reporting burden -- Estimated time to complete this form, including time for reviewing instructions and gathering and
providing the information needed to complete the form is 1 hour 45 minutes. Send comments regarding this burden or the content of
this form to: Corporation for National and Community Service (CNCS), Director, OGM, 1201 New York Avenue, NW,
Washington, DC 20525. CNCS informs the potential persons who are to respond to this collection of information that such persons
are not required to respond to the collection of information unless it displays a currently valid OMB control number on this page of
the form (see 5 CFR 1320.5(b)(2)(1))
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C. 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 for National and Community Service.
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
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No
No

Item
Table of Contents for Personnel/Employee Handbook/Manual
Table of Contents for Financial/Internal Controls Policy Manual
Delegations of Authority
Timekeeping Guide or Policy
Travel Guide or Policy
Procurement Guide or Policy
Standards for Use of Federal Funds Policy
Staff Code of Conduct / Statement of Ethics
Document Retention Policy

As of Date
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________

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
100-249

4.

50-99
> 500

What was the organization’s total budget for the last completed fiscal year?
$0 - $499,000
$5 M - $9,999,999

5.

10-49
250-500

$500,000 - $999,999
$10 M - $24,999,999

$1 M - $4,999,999
$25 M or more

What percentage of the total budget for the last completed fiscal year came from federal and state grants and contracts?
0 – 10%
31 – 40%
61 – 70%

11 – 20%
41 – 50%
71 – 80%

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21 – 30%
51 - 60%
81% or more

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III. Financial Management
6.

Indicate whether the Board has the following committees, and whether they are permanent (per By-Laws) or ad-hoc.
Executive Committee
Finance Committee
Audit Committee
Other – Please Specify:
________________________
________________________
________________________

7.

Permanent
Permanent
Permanent

Ad-Hoc
Ad-Hoc
Ad-Hoc

No

Do position descriptions exist for key financial management positions?
Yes

9.

Ad-Hoc
Ad-Hoc
Ad-Hoc

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

8.

Permanent
Permanent
Permanent

No

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:

10.

Who is responsible for approving / accepting the annual independent audit? (Check all that apply)
Audit Committee
Chief Financial Officer

11.

Board of Directors
Other (Specify):

Chief Executive

How often are financial reports prepared for executive staff?
Quarterly

12.

Board Chair
Finance Committee

Monthly

Weekly

Daily

Other specify: ____________________

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

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Other specify: ____________________

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13.

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

14.

No

Does the Board of Directors approve an annual fundraising plan?
Yes

No

IV. Financial Controls
15.

Does the organization maintain a chart of accounts?
Yes
No
If yes, please attach a copy of chart of accounts.

16.

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)
17.

How often do you post transactions to the general ledger?
Daily

18.

Weekly

Monthly

Annually

Other: _______________

Are at least two original signatures required on checks greater than 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? ____________________________________
19.

Are different staff members responsible for the distinct functions of reconciling cash receipts
and cash disbursement?

Yes

No

20.

Do distinct staff members authorize and maintain records of financial transactions?

Yes

No

21.

Does the organization use an automated payroll system?

Yes

No

22.

Does the organization follow a review and approval procedure when disbursing payroll?

Yes

No

23.

Is there a maximum amount that can be withdrawn from petty cash?

Yes

No

24.

Are receipts required for petty cash expenditures?

Yes

No

25.

Is Board approval required for any of the following financial transactions?
Opening / Closing Bank Accounts
Opening Lines of Credit
Assigning Credit Cards

Yes
Yes
Yes

No
No
No

Buying / Selling Property
Yes
No
Financial Investment / Divestment
Yes
No
Other specify: ________________________________

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26.

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?

27.

Who is authorized to write-off any debt owed the organization as a bad debt?
Accountant
Board Chair

28.

No

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

How often does the organization experience cash flow deficits?
Weekly

Yes

Monthly

Quarterly

Annually

No

None in last 2 years

V. Organizational Policies and Procedures
29.

How are the organization’s policies and procedures shared with employees? (Check all that apply)
e-mail
Memorandum
Orientation and training
Intranet
There is no existing procedure

30.

Management Informs
Other: ____________

When has training for relevant staff been provided in the following areas?
Subject Area
Financial/Accounting
Fundraising
Personnel/HR Issues
Risk Management
Other: _______________
Other: _______________
Other: _______________

31.

Employee Handbook
Staff meeting

Within 1 year

Within 2 years

Within 3 years

> 3 years ago

Never

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:______________________________________________________________
32.

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

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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

_____________________
Date

Typed Name of Preparer
_____________________________________
Telephone

Email

On the lines below, identify anyone else involved in the preparation of this survey by name and position title.

Privacy Statement -- In compliance with the Privacy Act of 1974, the following information is provided: The collection of this
information is authorized by the provisions of the National and Community Service Act of 1990, by the National and Community
Service Trust Act of 1993, and the Serve America Act of 2009. The primary purpose of the information is to determine if appropriate
systems are in place to manage federal grant funds or, if not, to identify training and technical assistance a new grantee may need to
develop and implement appropriate systems. CNCS requires new grantees which have never before received CNCS funds to complete
the form. Completion of this survey is required as an element of CNCS’ risk assessment process. The information provided will be
maintained and treated confidentially. However, appropriate federal, state, and local law enforcement entities may request and obtain
this information under certain circumstances. Otherwise, the information provided will not be disclosed without express written
permission.

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