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 than
$750,000 in 2014 in federal grants; or $500,000 in years prior to
2014)
Incurred Cost Accounting System
Timekeeping
Provide
url:
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:
Provide
url:
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
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
TIME
AND EFFORT REPORTING
Are
time distribution records maintained for an employee when his/her
effort can be specifically identified to a particular cost
objective?
Yes No
Not Sure
If
yes, attach
sample time sheet and/or procedures for allocating salary and
wage charges to Federal awards
FUNDS Management
Is
a separate bank account maintained for Federal grant funds?
Yes No
If
a separate bank 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 3095-0072.
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 (ISSD),
Room 4400, 8601 Adelphi Road, College Park, MD 20740-6001, and to the
Office of Management and Budget, Paperwork Reduction Project
(3095-0072), 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
ARCHIVES
AND
RECORDS
ADMINISTRATION Page
4
of 4 NA
Form 17003 (02-15)