AmeriCorps Applicant Operational and Financial Management Survey

AmeriCorps, the Agency, Public Reporting Burden Statement -- 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.

Organization Legal Name*

EIN*

City, State Associated with EIN*

UEI (Unique Entity Identifier)*

Prime Grant Identification Number Associated with Funding Opportunity*

Subgrant 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. Please indicate whether or not your organization has the policies/procedures below in place (select yes or no). 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.

Personnel/Employee Handbook*

YesNo

Financial/Internal Controls*

YesNo

Subaward and/or Service Site Monitoring and Oversight*

YesNo

Timekeeping*

YesNo

Travel guidance, including purchase/travel credit card use*

YesNo

Procurement*

YesNo

Standards for Use of Federal Funds*

YesNo

Code(s) of Conduct/Ethics, applicable to employment/purchasing*

YesNo

Document Retention*

YesNo

Operational Management

Please indicate the training areas below that are provided to employees by the organization (select yes or no).

Personnel/HR Issues*

YesNo

Financial Accounting*

YesNo

Risk Management*

YesNo

Cyber-Security*

YesNo

Fraud, Waste and Abuse*

YesNo

Financial Management

The activities 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. Please indicate whether or not your organization has the policies/procedures below in place (select yes or no). 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.

Are financial reports (profit and loss, budget vs. actual, etc.)provided to and reviewed by leadership level staff, at leastquarterly?*

YesNo

Does the organization utilize an automated accounting system?*

YesNo

Can the organization’s accounting system separate the receipts andpayments of a federal grant from the receipts and payments of theorganization’s other activities supported by separate fundingstreams?*

YesNo

Can the organization’s accounting system summarize expendituresfrom a federal grant according to different budget categories suchas salaries, rent, supplies, and equipment?*

YesNo

How often does the organization post transactions to the accountingsystem ledger(s)?*

Does the organization use an automated payroll system?*

YesNo

Financial Management

Please indicate whether organizational leadership approval is required for any of the following financial transactions (select yes or no).

Opening/Closing Bank Accounts*

YesNo

Opening Lines of Credit*

YesNo

Assigning Credit Cards*

YesNo

Buying/Selling Property*

YesNo

Financial Investment/Divestment*

YesNo

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

YesNoN/A

Please identify who is authorized to write-off any debt owed to theorganization as a bad debt.*

Has the organization experienced cash flow deficits an any point in the previous 2 years?*

YesNo

Compliance

Please respond as appropriate to the following prompts.

Has the organization received federal funds for similar programs or projects?*

YesNo

If so, has your organization met federal program requirements for similar programs?*

YesNoN/A

Has an audit been performed on the organization’s financial accounts?*

YesNo

If so, what was the audit opinion?*

ModifiedUnmodifiedAdverseN/A

If applicable, has the organization addressed any outstanding deficiencies identified in the most recent audit?*

YesNoN/A

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

Preparer's Certification

Please respond as appropriate to the following prompts.

Preparer's Name*

First NameLast Name

Preparer's Email*

example@example.com

Preparer's Position Title*

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

I CertifyI Do Not Certify

Date of Certification*

Date

AmeriCorps, the Agency, 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.