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.
Organization Name:
EIN:

DUNS Number:

Throughout this survey, documents are identified and copies requested. Provide copies of the most recent versions of all referenced and
requested documents. Check boxes to indicate which documents are attached. If you do not provide a document, please explain why it
is not being provided. If necessary, attach additional sheets in order to provide full responses to all questions.
I. Documents, Policies and Procedures
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 (single audit, or other audits if not subject to federal audit
requirements).
List of federal grants, contracts, and subgrants/sub-contracts using federal funds awarded to the organization in the last two
years including the grant and contract numbers, amounts and awarding agencies
B. Governance
Articles of Incorporation and By-Laws
Organizational Chart identifying: (a) key staff by name and title; (b) all budget and accounting office staff; (c) any staff with
responsibility to approve, record or reconcile financial records of any type; (c) identify all individuals permitted to approve
payroll; (b) all staff positions listed on the grant budget submitted to CNCS; and (d) all governing boards or councils, with
membership names and titles listed.

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, Chief Grants Officer, OGM, 250 E Street, SW, 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. If you are a first
time recipient of federal funds, your organization may not yet have these and other appropriate policies in place. As a recipient of federal
funds, you are required to have a full complement of financial, programmatic, and administrative polices, as well as internal controls in
place, as applicable.
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.
Provided
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No
No

Item

As of Date

Table of Contents for Personnel/Employee Handbook/Manual
Table of Contents for Financial/Internal Controls Policy Manual
Sub-award monitoring and oversight policy
Timekeeping Guide or Policy
Travel Guide or Policy, including purchase/travel credit card use
Procurement Guide or Policy
Standards for Use of Federal Funds Policy
Code(s) of Conduct/Ethics applicable to employment/purchasing
Document Retention Policy

_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________

II. General Information

1.

What year was the organization established? _________________________________

2.

What year did the organization receive its first federal grant? _____________________. If this is the first federal grant
received, what year do the organization receive its first federal contract? ________________________ .

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.

Identify the type of accounting system (cash or accrual): ______________________________

7.

Indicate whether the Board has the following committees, and whether they are permanent or ad-hoc.
Executive Committee
Finance Committee
Audit Committee
Other – List Below:
________________________
________________________

8.

Ad-Hoc
Ad-Hoc
Ad-Hoc

Permanent
Permanent

Ad-Hoc
Ad-Hoc

Do any paid employees serve as voting members of the Board of Directors, Tribal Council, or other governing body?
Yes

9.

Permanent
Permanent
Permanent

No

Identify key financial staff and incumbents’ education/experience. Provide position descriptions (PD), indicating Yes
(attached) or No (does not exist); if a PD does not exist explain why. If financial management services are contracted, enter
“outsourced” and describe the outsourced services; provide copy of contract and the vendor qualification requirements.
Position

Total Years Experience
Performing Similar Duties

Education

Position
Description
Attached?

10a. Chief Financial Officer or equivalent

_____________________

________________

_________

10b. Bookkeeper / Accountant or equivalent

_____________________

________________

_________

____________________________

_____________________

________________

_________

____________________________

_____________________

________________

_________

10c. 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 Chair
Finance Committee

Board of Directors
Other (Specify):

Chief Executive

Financial reports prepared for executive staff: Identify by frequency and type(s):
Is Report Compared to
Projections?

Report Type

_______________________________________________________

Yes
No

_______________________________________________________

Yes
No

_______________________________________________________

Yes
No

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Frequency
Annual
Quarterly
Monthly
Weekly
Annual
Quarterly
Monthly
Weekly
Annual
Quarterly
Monthly
Weekly

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12.

Identify who approves the organization’s operating budget and fundraising plan; e.g., Board of Directors. Enter “None” if
no approval process. Enter “N/A” if no operating budget or fundraising plan.
Annual Operating Budget Approved By: _______________________________________________________
Fundraising Plan Approved By: ______________________________________________________________

IV. Financial Controls
13.

Identify the accounting system name and software including version: ______________________________

14.

Does the organization maintain a chart of accounts?
Yes

No

If yes, attach copy of chart of accounts.
15.

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)
16.

How often do you post transactions to the accounting system ledger(s)?
Daily

17.

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 funds, including from federal sources?
Yes

No

If yes, what is the dollar threshold? ____________________________________
18.

Yes

Does the organization use an automated payroll system?

No

If yes, identify system and provider name: _________________________________
19.

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

20.

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

Yes

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

21.

Has the organization issued loans to an employee or officer of the organization or
forgiven / written-off any loan or debts in the last year?

22.

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

23.

Yes

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

How often does the organization experience cash flow deficits?
Weekly

No

Monthly

Quarterly

Annually
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None in last 2 years

No

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V. Organizational Policies and Procedures
24.

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

25.

Management Informs
Other: ____________

When training has been provided to staff on the following topics?
Subject Area
Financial/Accounting
Federal Grant Management
Personnel/HR Issues
Risk Management
Cybersecurity
Fraud, Waste, Abuse
Other: _________________

26.

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:______________________________________________________________
27.

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)
Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards (12/26/2013)
CNCS Regulations
Programmatic performance metrics and management
Budget development and execution
Federal cash management
Documenting in-kind and matching contributions
Avoiding common audit findings
Other: ______________________________________________________________________________________
Other: ______________________________________________________________________________________

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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

Printed Name and Title 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.

CNCS Receipt Record:

Date Received: ____________ CNCS Staff Print Name and Signature: _______________________________________________

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