6600-09 EPA Administrative Capability Questionnaire

U.S. ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460

OMB Control Number 2030-0020
Expiration Date 4/30/09

Appendix A
EPA Administrative Capability Questionnaire
The Environmental Protection Agency (EPA) uses the standards set forth in the Code of Federal Regulations, Title 40, Part 30,
Subpart C and Office of Management and Budget’s (OMB) Circular A-122 “Cost Principles for Non-Profit Organizations” to assess
the adequacy of administrative management systems. The regulation can be found on EPA=s website at
http://www.epa.gov/ogd/grants/regulations.htm or by searching the US Government Printing Office=s site at
http://www.gpoaccess.gov/cfr/index.html; the OMB Circular can be found on OMB’s website at:
http://www.whitehouse.gov/omb/circulars/a122/a122_2004.html. If your organization is being recommended for an EPA grant, and
your organizational policies and procedures do not fully cover the areas outlined in the questionnaire, revised or new policies may be
necessary to comply with Federal financial management standards.
PART I - GENERAL
1.
2.
2a
3.
4.
5.
6.
7.
8.

9.
10.
11.

Legal Name of the Organization
Other Organizational Names or Acronyms Used
Please Identify any affiliated organizations
Dun and Bradstreet (D&B) Data Universal Numbering
System (DUNS) Number
Is your accounting system accrual based or cash based?
Is your accounting system manual, automated or
combination?
Has an audit been performed on the organization’s
financial statement?
What was the audit opinion?
If the organization has expended more than $500,000 in
federal grant funds within a year, has an A-133 audit been
performed?
If yes, were there any major findings?
Does the organization have an approved indirect cost rate
with the Federal government?
Has the organization filed any certification/questionnaire
regarding its financial managements systems to other
Federal agencies? If yes, please list and provide a copy.

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OMB Control Number 2030-0020
Expiration Date 12/31/05
PART II - ADMINISTRATIVE CAPABILITY
Instructions: Check the appropriate box to the right for each item. If your organization has written
policies/procedures that meet the requirement, check the box under the AYes@column. If your organization does not
have written policies/procedures that meet the requirement described under this column, check (/) the box under
the ANo@column and explain in the box or in an attachment. Please provide EPA a copy (electronic is preferable) of
the following items: 1) Most recent audit of financial statements and management letter, 2) procurement and
property policies, 3) personnel policies and 4) travel policy. EPA will evaluate your responses against these items.
STANDARDS FOR FINANCIAL MANAGEMENT SYSTEMS
1.

Does your accounting and financial management system(s) follow Generally Accepted Accounting Principles? (OMB
Circular A-122, Attachment A, A(2)(e))

2.

Is your financial management system(s) able to relate financial data to performance data and develop unit cost
information? (40 CFR 30.21(a))

3.

Can your financial management system(s) provide accurate, current and complete disclosure of the financial results of
each federally-sponsored project or program in accordance with the requirements of 40 CFR 30.52? These are the
Financial Status Report and Report of Federal Cash Transactions. (40 CFR 30.21(b)(1))

4.

Can your financial management system(s) provide records that adequately identify the source and application of funds
for federally-sponsored activities? Information to be included is: authorizations, obligations, unliquidated
obligations, assets, outlays, income and interest. (40 CFR 30.21 (b)(2))

5.

Does your financial management system(s) provide for effective control over and accountability for all funds, property
and other assets, including ensuring that all such assets are used solely for authorized purposes? (40 CFR 30.21
(b)(3))
Can your financial management system(s) provide for a comparison of outlays with budget amounts for each award,
including, where appropriate, information related to performance and unit cost? (40 CFR 30.21(b)(4))

6.
7.

Does your financial management system(s) provide written procedures to minimize the time elapsing between the
transfer of funds to the recipient from the U.S. Treasury and the issuance or redemption of checks, warrants or
payments by other means for the purposes of the program? (40 CFR 30.21(b)(5))

8.

Does your financial management system(s) provide written procedures for determining the reasonableness, allocability
and allowability of costs in accordance with OMB Circular A-122, “Cost Principles for Non-Profit Organizations”?
(40 CFR 30.21(b)(6))

9.

Does your financial management system(s) provide accounting records which include cost accounting records
supported by source documentation? (40 CFR 30.21(b)(7))

10
.

If applicable, does your financial management system(s) provide procedures for conducting an audit in accordance
with OMB Circular A-133? Currently, A-133 audits are required for recipients expending $500,000 or more in
federal funds during the fiscal year. (40 CFR 30.26(a))

11
.

Does your financial management system(s) provide or describe existing or planned indirect cost rates? ( OMB
Circular A-122 Attachment A, Sections C and D)

PROPERTY AND PROCUREMENT STANDARDS

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Yes

No
(explain)

OMB Control Number 2030-0020
Expiration Date 12/31/05
Instructions: Check the appropriate box to the right for each item. If your organization has written
policies/procedures that meet the requirement, check the box under the AYes@column. If your organization does not
have written policies/procedures that meet the requirement described under this column, check (/) the box under
the ANo@column and explain in the box or in an attachment. Please provide EPA a copy (electronic is preferable) of
the following items: 1) Most recent audit of financial statements and management letter, 2) procurement and
property policies, 3) personnel policies and 4) travel policy. EPA will evaluate your responses against these items.
1.

Does your property management system(s) provide for maintaining: (1) a description of the equipment; (2) an
identification number; (3) source of the property, including the award number; (4) where title vests; (5) acquisition
date; (6) federal share of property cost; (7) location and condition of the property; (8) acquisition cost; (9) ultimate
disposition information? (40 CFR 30.34(f)(1))

2.

Does your property management system(s) provide for a physical inventory and reconciliation of property at least
every two years? (40 CFR 30.34(f)(3))

3.

Does your property management system(s) provide controls to insure safeguards against loss, damage or theft of the
property? (40 CFR 30.34(f)(4))

4.

Does your property management system(s) provide for adequate maintenance of the property? (40 CFR 30.34(f)(5))

5.

Does your organization maintain written procurement procedures which (1) avoid unnecessary purchases; (2) provide
an analysis of lease and purchase alternatives; and (3) provide a process for soliciting goods and services? (40 CFR
30.44(a))

6.

Does your procurement system provide for the conduct and documentation of cost or price analysis for each
procurement action? (40 CFR 30.45)

PERSONNEL AND TRAVEL
1.

Does your organization maintain written standards of conduct governing the performance of your employees engaged
in the award and administration of contract (i.e., conflict of interest) and does it provide for disciplinary actions? (40
CFR 30.42)

2.

Does your organization maintain a personnel system(s) which provides monthly reports on the activities of each
employee whose compensation is charged to the assistance agreement? (OMB Circular A-122, Attachment B, 8(m))

3.

Does your organization maintain a standard travel policy? (OMB Circular A-122, Attachment B, 51(b))

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Yes

No
(explain)

OMB Control Number 2030-0020
Expiration Date 12/31/05
PART III - CERTIFICATION AND SUBMISSION
CERTIFICATION OF APPLICANT=S AUTHORIZED REPRESENTATIVE (REQUIRED):
I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any
knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
Name_________________________________________________________
Title__________________________________________________________
Signature______________________________________________________

Date_____________________________________________________

SUBMISSION INSTRUCTIONS:
Submit questionnaire with documentation at least 60 days prior to your proposed project start date to [EPA EMAIL ADDRESS]. If
you do not have internet access, mail the questionnaire and supporting documentation to the following address:
US Environmental Protection Agency (EPA)
[MAILING ADDRESS]
Attn: [NAME OF CONTACT]
If the signed document is submitted by email, it must be submitted in a computer file format, such as Portable Document Format
(PDF) developed by Adobe Systems, Inc., that allows authors to exchange documents among different computer systems, while
preserving the documents' typography and page layout.

The public reporting and recordkeeping burden for this collection of information is estimated to average 4 hours per response. Send comments on the Agency's need for
this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection
techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB
control number in any correspondence. Do not send the completed form to this address.

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