State, Local, Tribal Competitive

UNITED STATES DEPARTMENT OF AGRICULTURE

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Food and Nutrition Service

OMB APPROVED NO. 0584-XXXX
Expiration Date: MM/DD/YYYY

GRANT PROGRAM ACCOUNTING SYSTEM & FINANCIAL
CAPABILITY QUESTIONNAIRE
PAPERWORK REDUCTION ACT
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0584-XXXX The time required to complete this information collection is estimated to average 1 hour per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park
Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-XXXX). Do not return the completed form to this address.

PURPOSE
Recipients of Federal funds must maintain adequate accounting systems that meet the criteria outlined in 2 CFR §200.302 Standards
for Financial and Program Management. The responses to this questionnaire are used to assist in the Food and Nutrition Service
Agency’s (FNS) evaluation of your accounting system to ensure the adequate, appropriate, and transparent use of Federal funds.
Failure to comply with the criteria outlined in the regulations above may preclude your organization from receiving an award. This form
applies to FNS’ competitive and noncompetitive grant programs

ORGANIZATION INFORMATION
Legal Organization Name:
D-U-Ns Number:

FINANCIAL STABILITY AND QUALITY OF MANAGMENT SYSTEMS
Requirement
1.

Has your organization received a Federal award within the past 3 years?

2.

Does your organization utilize accounting software to manage your financial records?

3.

Does your accounting system identify the receipt and expenditure of program funds separately for each grant?

4.

Does your organization have a dedicated individual responsible for monitoring organizational funds, such as an
accountant or a finance manager?

5.

Does your organization separate the duties for staff handling the approval of transactions and the recording and
payment of funds?

6.

Does your organization have the ability to specifically identify and allocate employee effort to an applicable
program?

7.

Does your organization have a property/inventory management system in place to track location and value of
equipment purchased under the award?

Yes

No

Yes

No

AUDIT REPORTS AND FINDINGS
Requirement
1.

Has your organization been audited within the last 5 fiscal years? (If the answer is “Yes” and this report was
issued under the Single Audit Act please note this in the box below marked “Additional Information” and if not
issued under the “Single Audit Act”, please attach a copy or provide a link to the audit report in the Hyperlink
space below).

2.

If your organization has been audited within the last 5 fiscal years, was there a “Qualified Opinion” or an
“Adverse Opinion”?

3.

If your organization has been audited within the last 5 fiscal years, was there a “Material Weakness” disclosed?

4.

If your organization has been audited within the last 5 fiscal years, was there a “Significant Deficiency”
disclosed?

FORM FNS-906 (04-19) Previous Editions Obsolete

SBU

Electronic Form Version Designed in AEM 6.4

Hyperlink (if available):
Additional information including expanding on responses in previous sections:

APPLICANT CERTIFICATION
I certify that the above information is complete and correct to the best of my knowledge.

Authorized Representative’s Signature

Date

Name:
Phone:
Email:

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