NIFA-666 Organizational Information

UNITED STATES DEPARTMENT OF AGRICULTURE

OMB approved 0524-0026
Expires XX/XX/XXXX

NATIONAL INSTITUTE OF FOOD AND AGRICULTURE

ORGANIZATIONAL INFORMATION

(Note: Identify attached information by the corresponding number and item of this form)
1. LEGAL NAME OF ORGANIZATION

CONGRESSIONAL DISTRICT

2. COMPLETE BUSINESS ADDRESS (Including zip code)

3.

KEY OFFICIAL

NAME

TITLE

a. Chief Executive

TELEPHONE NUMBERS/E-MAILS
Office: ________________________
E-mail: _________________________

b. Authorized Representative (AR)
(Individual authorized to commit the
organization's resource to proposed
projects. The entity can have multiple
Authorized Representatives however,
award letters will be addressed to the
Primary Authorized Representative
only.)

PRIMARY:

PRIMARY:

ADDITIONAL:

ADDITIONAL:

Office: ________________________

E-mail: ________________________

Office: ________________________

c. Business Officer/Financial
Manager (Person responsible for
monitoring organization’s funds)

E-mail: _______________________

4. ORGANIZATION TYPE
[ ] College/University
[ ] State or Local Government
[ ] Public Secondary or Post-Secondary School
[ ] Other (Specify):

[
[
[
[
[
[

]
]
]
]
]
]

Commercial Organization
Partnership
Proprietorship (unincorporated)
Corporation
For-Profit
Non-Profit (submit a copy of your current IRS tax exempt letter)

5.

ORGANIZATION AFFILIATIONS - On a separate sheet, describe any relationship of the organization to a parent organization or to subsidiaries of other affiliates. If the organization is a
successor in interest to a predecessor or if changes in organizational affiliation are anticipated, describe briefly. If any key official is affiliated with another organization in any capacity,
describe the relationship.

6.

STATEMENT OF PURPOSES AND POWERS - If appropriate to the type of organization, provide the Articles of Incorporation and By-Laws. A partnership should provide the
partnership agreement that shows ownership and control requirements. An LLC should provide Articles of Organization and any amendments and Operating Agreement and any
amendments.

7.

FINANCIAL INFORMATION
a. On a separate sheet, describe the policies and procedures of your organization’s internal controls for the administration and financial management of the project for which USDA
assistance is being requested. This should include details of your cost accounting system and auditing arrangements. Reference the Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards found at 2 CFR Part 200.
i. Provide information on how your accounting system adequately identifies receipts and expenditures for each grant or contract and whether a unique
general ledger account has been established to capture/accumulate the costs of NIFA’s grant apart from other grants and cost centers.
ii. Describe how your accounting system provides for recording of expenses for each program by budget cost category.
iii. Describe how time and effort reporting records are maintained for salary expenditures charged to NIFA and other grants. Are time sheets or other
time distribution records maintained for each employee to account for 100 percent of their work hours?
b. If your organization is other than a college or university or a state or local government, attach:
i. Certified financial records for the preceding two years consisting of audit reports prepared by a CPA or year-end balance sheets and income
statements. Tax returns are not acceptable.
ii. Documentation regarding the organization’s policy on salary compensation and how rates of pay are determined for employees.
iii. Certification that the organization is not delinquent in the payment of Federal taxes.
iv. Provide a listing of previous Federal grants received to include the Federal awarding agency, amount received, and the date awarded.
c. If indirect costs are requested under this proposal, submit a copy of the current Negotiated Indirect Cost Rate Agreement (NICRA) from the cognizant Federal agency.
Organizations that do not have a current negotiated rate, may elect the de minimis rate (2 CFR 200.414). Billing rates will be evaluated by NIFA to ensure that unallowable costs,
such as IR&D are not included in the cost pools. If unallowable costs are discovered, NIFA will offer an adjusted rate. If a recipient has no NICRA but possesses an active award
from another Federal agency that includes a safe rate, that rate may be considered for match by NIFA. Any of the previously mentioned rates must be active, not expired.

8. SBIR OR STTR AWARDEES - Complete and sign the Funding Agreement Certification provided with this form and return with other requested documentation.
9. REMARKS:

CERTIFICATION
1. I certify that ___________________________________________________________ has legal authority to accept
(Name of organization)

Federal awards and has in place the requisite policies, procedures, and personnel to ensure stewardship of Federal funds
and management of Federally supported projects, specifically including standards for financial management,
procurement, and property management, which meet those described in USDA regulations found in 2 CFR Chapter IV.
2. Each proposal submitted to the National Institute of Food and Agriculture will be consistent with the procedures,
policies, and goals of the named organization.
3. In the event that an award is made as a result of any such proposal, the above-named organization will:
A.

Make available the necessary facilities, equipment, services, and personnel to conduct the project funded
under the award substantially as outlined in the proposal or such modifications thereof as may be mutually
agreed upon by the above-named organization and the National Institute of Food and Agriculture.

B.

Conduct such project oversight as may be appropriate, manage the Federal funding with probity and
prudence, and comply with all the terms and conditions of the award.

C.

Ensure that costs incurred under the award are reasonable, necessary, allocable, and allowable pursuant to
the applicable program legislation, the purpose of the award, the terms and conditions of the award, and the
following Federal cost principles applicable to the above organization as in effect at the time of award:
1) 2 CFR 200, Subpart E-Cost Principles
2) 45 CFR Part 74, Appendix E, "Principles for Determining Costs Applicable to Research and Development
under Grants and Contracts with Hospitals" (Also see 2 CFR Appendix IX.)
3) 48 CFR Part 31 (Federal Acquisition Regulations (FAR)), "Contract Cost Principles and Procedures"

D.

Comply with all applicable laws and regulations.

TYPED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE

DATE

Public reporting for collection of information is estimated to average XX minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information,
unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to NIFA, OGFM, 2312 East Bannister Road, Mail Stop 10,000, Kansas City, MO 64131, Attention Policy Section. Do not return the completed form to this address. National
Institute of Food and Agriculture US Department of Agriculture OMB No. 0524-0026 Form Approved For Use Through XX/XX/XXXX