Form 1 Financial Management Survey

This is a view only version of the Applicant Operational and Financial Management
Survey (OFMS). Applicants should submit their OFMS via the link in the NOFO.
Applicants should NOT download this and attempt to submit via email. Thank you.

Applicant Operational and
Financial Management Survey
OMB Control Number 3045-0102
Expiration: 09/30/2024
This survey is intended to collect information about the capacity of
applicants to manage federal grant funds. Per 2 CFR §200.206,
AmeriCorps must evaluate the degree of risk posed by an applicant.
Information from the survey will be used to assess an organization’s
operational and financial management capabilities prior to receiving a
federal award. 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 preparing this form are
those responsible for, and with sufficient knowledge of, the organization’s
operational and financial management functions. The information
provided may be used to support future monitoring activities, should the
applicant receive federal funds from AmeriCorps. In completing this form,
each question requires a response. Refer to the applicable Notice of
Funding Opportunity for instructions on how to submit all application
materials.
* Required

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 2 hours.£ Send comments regarding this
burden or the content of this form to:£ AmeriCorps, Office of Grants
Administration, 250 E Street, SW, Washington, DC£ 20525.£
AmeriCorps£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)).
NOTE: An organization must complete a separate Operational and Financial
Management Survey form for each application it submits under the
applicable Notice of Funding Opportunity. Please also note that£the final
‘Submit’ button must be clicked for your form to be submitted.

General Information
1. Organization Legal Name: *

2. EIN *

3. City, State Associated with EIN *

4. UEI (Unique Entity Identifier) *

5. Assistance Listing Number Associated with Funding Opportunity *

6. Application Identification Number *

Operational Management
The policies identified below address some of the most critical elements for
administration of a federal grant.£ As a recipient of federal funds,
organizations are required to have a full complement of programmatic,
financial, and administrative policies, as well as internal controls in place, as
applicable. Policies and procedures should be reviewed and refined, as
applicable, at least once every two years. Should the applicant receive federal
funding from AmeriCorps, full copies of the policies and procedures may be
requested for monitoring purposes.
Please indicate whether the organization has current written policies
and procedures in the following areas (select Yes or No):
7. Personnel/Employee Handbook *
Yes
No

8. Financial/Internal Controls *
Yes
No

9. Sub-award and/or Service Site Monitoring and Oversight *
Yes
No
N/A

10. Timekeeping *
Yes
No

11. Travel Guidance, including purchase/travel credit card use *
Yes
No

12. Procurement *
Yes
No

13. Standards for Use of Federal Funds *
Yes
No

14. Code(s) of Conduct/Ethics, applicable to employment/purchasing *
Yes
No

15. Document Retention *
Yes
No

Operational Management
Please indicate the training areas below that are provided to employees
by the organization (select Yes or No)
16. Personnel/HR Issues *
Yes
No

17. Financial Accounting *
Yes
No

18. Risk Management *
Yes
No

19. Cyber-security *
Yes
No

20. Fraud, Waste, and Abuse *
Yes
No

Financial Management
21. Are financial reports (profit and loss, budget vs. actual, etc.)
provided to and reviewed by leadership level staff, at least
quarterly? *
Yes
No

22. Does the organization utilize an automated accounting system? *
Yes
No

23. Can the organization’s accounting system separate the receipts and
payments of a federal grant from the receipts and payments of the
organization’s other activities supported by separate funding
streams? *
Yes
No

24. Can the organization’s accounting system summarize expenditures
from a federal grant according to different budget categories such
as salaries, rent, supplies, and equipment? *
Yes
No

25. How often does the organization post transactions to the accounting
system ledger(s)? *
Daily
Weekly
Monthly
Quarterly
Annually
Other

26. Does the organization use an automated payroll system? *
Yes
No

Financial Management
Please indicate whether organizational leadership approval is required
for any of the following financial transactions (select Yes or No):
27. Opening/Closing Bank Accounts *
Yes
No

28. Opening Lines of Credit *
Yes
No

29. Assigning Credit Cards *
Yes
No

30. Buying/Selling Property *
Yes
No
N/A

31. Financial Investment/Divestment *
Yes
No
N/A

32. Has the organization issued loans to an employee or officer of the
organization or forgiven/written-off any loans or debts in the last
year? *
Yes
No
N/A

33. Please identify who is authorized to write-off any debt owed to the
organization as a bad debt. *
Accountant
Chief Financial Officer
CEO/Executive Director
Board Committee
Board Chair

34. Has the organization experienced cash flow deficits an any point in
the previous 2 years? *
Yes
No

Compliance
35. Has the organization received federal funds for similar programs or
projects? *
Yes
No

36. If so, has your organization met federal program requirements for
similar programs? *
Yes
No
N/A

37. Has an audit been performed on the organization’s financial
accounts? *
Yes
No

38. If so, what was the audit opinion?
Modified
Unmodified
Adverse
N/A

39. If applicable, has the organization addressed any outstanding
deficiencies identified in the most recent audit? *
Yes
No
N/A

40. Please provide any clarifications or similar remarks/information in
the section below (optional):

Preparer’s Certification
41. Preparer’s Name (First, Last) *

42. Preparer’s Email *

43. Preparer’s Position Title *

44. I certify that the above information is complete and correct to the
best of my knowledge and ability. *
I Certify
I Do Not Certify

45. Date of Certification *
Please input date (M/d/yyyy)

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 grantee may need to
develop or enhance appropriate systems. Completion of this survey is
required as an element of CNCS’ pre-award 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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