Risk Rating: N/A=0, Low=0, Med=1, High=2

Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000

FHI 360 administers a financial pre-award assessment of organizations proposed to receive a subaward. This questionnaire is designed to be administered to organizations in which the proposed estimated subaward life of project value is more than US$150,000. The assessment is to be completed by FHI 360 designated finance staff and only when impractical, the questions may be answered by the organization’s senior finance staff but the individual and overall rating must be assigned by FHI 360 designated finance staff.

The pre-award assessment considers the organization’s ability to: (1) Manage and account for the amount of funds FHI 360 will award, (2) Comply with terms and conditions of the subaward; and (3) Inform the organization of FHI 360’s accounting record expectations and requirements.

At the pre-awards conclusion, observations of the organization’s financial systems are summarized and a recommendation is made. The results of the performance of the financial pre-award assessment are included in FHI 360’s Memorandum of Negotiation document. The pre-award assessment should be conducted early in the subaward process so that the results and recommendations can be incorporated and accounted for in the budget review and subaward, as necessary.

Upon completion, scan and email signed completed PAT to [email protected]. This requirement is MANDATORY. Be sure to copy the CMS’s PMT or local Grant Administrator who worked with the project staff on the proposed subaward.

Organization’s Details Legal Name of the Organization 1st Principal’s Name & Title 2nd Principal’s Name & Title Address Telephone Fax Email Address Web Address DUNS Number (for USG awards only) Yes No N/A Has Financial Conflict of Interest Policy as applicable to U.S. PHS agencies’ funding. E.g. NIH, CDC, AHRQ. Organization Type Not for Profit or Nongovernmental University Governmental For Profit Other:

Proposed Subaward Details Project Title FHI 360 COMPASS Project Number (min 12 Operations Unit digits) FHI 360 Originating Funder Country Of Performance FHI 360 Grant Administrator FHI 360 Program/Technical Staff Contact FHI 360 Originating Award Type Subaward Period of Performance Subaward Life of Project Value (Estimated) Subaward Type (Proposed)

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 1 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 Instructions: Use professional judgment and complete the assessment. The assessment is to be completed by FHI 360 designated finance staff and when impractical, the questions may be answered by the organization’s senior finance staff but the rating must be assigned by FHI 360 designated finance staff. Using a scale of 0-2, FHI 360 designated finance staff answers the assessment questions and rates the risk based on the answer. Assign the numerical value to the risk rating as follows:

Risk Rating: N/A=0 Low=0 Med=1 High=2 Upon completion, scan and email signed completed PAT to [email protected]. This requirement is MANDATORY. Be sure to copy the CMS’s PMT or local Grant Administrator who worked with the project staff on the proposed subaward.

Risk Rating: N/A=0 Low=0 Med-1 High=2 To be completed For all sections: To be completed by FHI 360 designated finance by FHI 360 staff and only when impractical, the questions may be designated finance A. General Organization Information answered by the Organization’s senior finance staff. staff Only 1. Is the organization incorporated or legally Yes (low) Provide registration number: registered? No (med, high), explain

2. City and country of incorporation or legal registration: No Rating

3. Date of incorporation or legal registration: No Rating 4. For the current period, have the financial N/A reporting and audit requirements associated Yes (low) with the registration been fulfilled? If no, what is pending? No (med, high), explain

5. Is the organization tax exempt for Value Added N/A Tax (VAT) or Goods and Service Tax (GST)? Yes (low) No (med, high), explain if an alternative option is available:

6. Please list the number of employees of the Full-time employees organization: Part-time employees No Rating 7. Enter the organization’s fiscal year: No Rating Comments: General Organization Information Rating Total (max 6):

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 2 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2

B. Internal Audits and Financial Statements 1. Has the organization undergone an internal If no internal audit =(high) financial audit or review during the current or Yes (med, low) prior fiscal year? No ( high) 2. Review the Statement of Financial Position If no Statement of Financial Position =(high) (Balance Sheet/Statement of Net Assets). Are Yes (low) the current assets minus the current liabilities positive? No (med/high) 3. Review the Statement of Financial Position If no Statement of Financial Position =(high) (Balance Sheet/Statement of Net Assets). Does Yes (low) the organization have a positive “Unrestricted Net Assets”? No (med/high) Comments: Internal Audits and Financial Statements Rating Total (max 6):

C. Financial Management Banking 1. Are the liquid assets (cash) of the organization Yes (low) Name of the organization’s bank? kept in a bank account?

No (med, high), explain

2. If FHI 360 anticipates providing an advance of N/A USG funds to the organization; does local Yes (low) practice and regulations permit the organization to open an interest bearing bank No (med, high) account? (Refer to 2 CFR 200.305(b) (8), and USAID ADS 303, and other applicable regulations.) – See Question C9 and C10 to determine if this will be a special award condition for the sub-awardee Funding No (med, high) 3. Has the organization received funding similar to the proposed subaward (U.S. Government, xyz Yes (med, low) foundation etc.) in the last 3 years? Recommended to request award letter/document. Please identify the source and specify the amount(s) received from each source, by year below:

Source Amount Yr(s)

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 3 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 4. Based on the organization’s current year fiscal Current Fiscal budget, list the organization’s expected sources Source Year Planned Prime Receipts Funder and planned receipts for the current fiscal year. Identify the prime funder (U.S. Government, xyz foundation etc).

No Rating Accounting Staff 5. How many employees are in the Accounting Department and what are their names and key Number of Staff in Accounting Dept. responsibilities?

Name Key Responsibilities

No Rating 6. What is the background (work and education Work and education qualifications qualifications) of the Accountant for the project? (low, med, high risk depending on work and education qualifications) 7. Is it necessary to train the accountant prior to No (low) the implementation of the project? Yes (med, high), explain Accounting System No system (high) 8. Is the accounting system manual or automated? Manual (med) If automated, what is the accounting software program used? Specify. Automated (low, med) Accounting Software System:

9. Is the accounting system capable of tracking Yes (low) and documenting the receipts of awarded funds No (med, high), explain by source (funder/award)?

10. Is the accounting system capable of tracking Yes (low) and documenting the utilization of awarded No (med, high), explain funds by source (funder/award)?

11. Does the organization use a written chart of Yes (low) accounts containing a description of each No (med, high), explain account?

12. Does the organization have written accounting Yes (low, med) policies and procedures? No (high)

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 4 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 13. What accounting records are kept? (Indicate date of last entry.) Yes Date of last /No entry a. General ledger Yes No b. Cash receipts Yes ledger No c. Cash Yes disbursements No ledger d. Bank book Yes No e. Petty cash Yes book No f. Payroll register Yes No g. Fixed Asset Yes register No h. Advance Yes Ledger No

Segregation of Duties Yes (low) 14. Are there adequate segregation of duties Preparer (name/title/position): between preparer, reviewer and approver for

payments? Reviewer (name/title/position):

Approver (name/title/position):

No (med, high), explain ______15. Is it the policy and practice that four different Yes (low) persons: No (med, high), explain . prepare checks/EFT/internet banking, and . authorize the payments, and . reconcile bank accounts, and . have access to receipts? Documentation Yes (low) 16. Are pre-numbered forms used to record all of No (med, high), explain the financial transactions and account for the sequence of all numbers used?

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 5 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 17. Are key records matched before a transaction is Yes (low) approved (i.e., matching purchase order, No (med, high), explain receiving report, and vendor invoice before the invoice is approved for payment)?

18. Are copies of proof of payment (e.g. checks, Yes (low) EFTs, internet banking) attached to the No (med, high), explain payment voucher?

19. Are the source documents canceled (e.g. Yes (low) stamped “PAID”) after processing to provide No (med, high), explain assurance that the same documents will not be reused and will not result in recording transactions more than once (i.e., only original documents are used to process transactions)? 20. Will the supporting documentation (e.g. Yes (low) invoices, vouchers, time sheet hours) related to No (med, high), explain the FHI 360 project be maintained separately, marked, or coded so that that the cost therein are clearly distinguishable from non-FHI 360 If yes, indicate how: : projects? Payroll Yes (low) 21. Is each employee’s salary documented in an No (med, high), explain employment letter or contract?

22. Is a personnel action (or similar) form used to Yes (low) document salary revisions? No (med, high), explain

23. For new hires, does the organization have Yes (low) written policies and a salary scale to guide them No (med, high), explain in establishing new hires salaries?

24. Provide an example of an employee’s N/A completed time sheet, if applicable. Provided (low, med) Not Provided (med, high), Not Provided. If not provided, explain how organization will comply with US Gov’t 2 CFR 200.430 (i) Standards for Documentation of Personnel Expenses which require charges to U.S. Federal awards for salaries and wages to be based on records that accurately reflect the work performed. Explain, if applicable. Explain 25. Does the time sheet detail the employee’s N/A hours worked each day by project (i.e., FHI 360 Yes (low) hours worked and non FHI 360 hours)? No (med, high), explain

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 6 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 26. Does the organization use the employee’s N/A approved time sheets to allocate payroll? Yes (low) No (med, high), explain

27. Is the organization complying with government N/A payroll tax withholding regulations? If not, Yes (low) explain. No (med, high), explain

28. Does the organization have a written policy to N/A support fringe benefits (leave, medical, pension Yes (low), describe and other benefits)? No(med, high), explain

29. Does the organization have written policies and Yes (low) procedures that govern the conduct of ethics No (med, high) and conflicts of interest?

Petty Cash N/A 30. Does the organization maintain petty cash on Yes (low) What is the imprest petty cash the imprest system? amount: ______No (med, high), explain

31. Does the organization have a written petty cash N/A policy that addresses petty cash management Yes (low) and segregation of such duties (e.g. Who keeps the petty cash? What expenses are paid and No (med, high), explain what documentation is obtained to support the expense)?

Financial Reports and Budgets Yes (low) 32. Are the financial statements/reports prepared Preparer’s Name & Title: by authorized personnel having sufficient

experience and expertise to ensure compliance

with applicable accounting principles? No (med, high), explain

33. How frequent does the organization prepare Monthly (low) financial statements/reports? Quarterly (med) Annually (high) 34. Are financial monitoring systems in place to Yes (low) ensure that budgets are not exceeded (i.e. costs No (med, high), explain compared with approved budgets and variances explained)? 35. Does the organization input funders’ budgets Line item amounts (low) into the accounting systems by line item Major cost categories (low, med) amounts, by total budget or neither?

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 7 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 Total (high) Neither (high) Travel and Workshops 36. Does the organization have a written travel Yes (low) policy that addresses meals, accommodations, No (med, high), explain fuel, mileage, and other related travel cost?

37. For meetings and workshops is there a written N/A policy that describes adequate supporting Yes (low) documentation for participant’s expenses and attendance records? No (med, high), explain

38. Does the organization have a system to track N/A advances (e.g. travel, workshops) they issue to Yes (low) ensure that they are appropriately accounted for and documented? How is the difference in No (med, high), explain the amount advanced and actually paid resolved? How resolve advance vs. paid: Comments: Financial Management Rating Total (max 72):

D. Procurement, Property and Commodities Management Systems 1. Does the organization have a written Yes (low) procurement policy? No (med, high), explain

2. Does the organization always solicit quotations Yes (low) from vendors before making a purchase over No (med, high), explain the local currency equivalent of $3,000 (organization may have more restrictive policy)? 3. When dealing with US government funded N/A projects, are terrorism and debarment searches Yes (low) performed of potential vendors, employees, consultants and subrecipients? No (med, high), explain

4. Are secured facilities used when appropriate, Yes (low) and access to equipment and commodities No (med, high), explain limited to authorized personnel?

5. Are the commodities maintained in a secure N/A storage facility that meet the temperature and Yes (low) humidity requirements and are free from rodents, insects, oil and water damage? No (med, high), explain

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 8 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 6. Does the organization use inventory stock cards Yes (low) to manage commodities and supplies? No (med, high), explain

7. Does the organization have adequate controls N/A to ensure that obsolete commodities are not Yes (low) distributed? (Commodities; such as medical supplies, pharmaceuticals, condoms and No (med, high), explain printed media materials, etc.) 8. Are different individuals responsible for Yes (low) purchasing goods, receiving goods, and No (med, high), explain approving vouchers?

9. Are incoming and outgoing assets counted, Yes (low) inspected, and received or released on the basis No (med, high), explain of proper authorization in accordance with established procedures? 10. Does the organization maintain a fixed asset Yes (low) listing of non-expendable property containing No (med, high), explain the following? (Description, serial number, acquisition cost, acquisition date, unique fixed asset number assigned by the organization, location, current condition, and funding source.) 11. Are assets on hand periodically (at least yearly) Yes (low) inspected and counted, and the results No (med, high), explain compared with the asset records?

Comments: Procurement , Property and Commodities Management Systems Rating Total (max 22):

E. Reports and Records 1. Are secured facilities used when appropriate, Yes (low) and access to critical forms and equipment No (med, high), explain limited to authorized personnel?

2. Is access to computer programs and data files Yes (low) restricted to authorized personnel only? No (med, high), explain

3. Are procedures in place to provide reasonable Yes (low) assurance that current files can be recovered in No (med, high), explain the event of a computer failure?

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 9 | P a g e Risk Rating: N/A=0, Low=0, Med=1, High=2 4. Does the organization retain accounting Yes (low) records, including invoices, vouchers and time No (med, high), explain sheets, for at least three years after the final invoice is submitted to the funder? (Note: Ensure that the organization’s record retention schedule meets FHI 360 originating funder’s requirements.) Comments: Reports and Records Rating Total (max 8):

F. Insurance 1. Does the organization maintain Property, Property/Vehicle Insurance: Yes (low) General Liability or Other types of insurance? If yes, copies of current insurance certifications No (med, high) (or insurance policy) should be available for review as applicable to the project. Consider the project/prime funders requirements. General Liability Insurance: Yes (low)

No (med, high)

Other (specify): Yes No Nature of Coverage: Comments: Insurance Rating Total (max 2):

G. Indirect Rate 1. Does the organization have an established, N/A overhead, or administrative rate, such as an Approved NICRA Rate (low) approved US Government negotiated indirect cost rate (NICRA)? Audited Indirect Rate (med, high) No (high), explain

Comments: Indirect Rate Rating Total (max 2):

H. Shared Cost Allocation Plan 1. If the organization has multiple funder’s – will N/A the organization use a shared cost allocation Yes (low) plan, to allocate direct cost such as; rent, utilities, administrative supplies, consistently No cost allocation plan (med, high), explain and equitably between all funders? Comments: Shared Cost Allocation Plan Rating Total (max 2):

I. 2nd Tier subs 1. Does the organization have a financial pre- N/A award questionnaire/process in which it Yes (low) administers to 2nd Tier-subawardees? No (med, high), explain

2. Does the organization have written policies and N/A procedures for monitoring 2nd tier Yes (low) subawardees? No (med, high), explain

3. Will each 2nd tier subawardee’s expenses be N/A easily identifiable in the organization’s financial Yes (low) accounting reports? No (med, high), explain

4. Will funds advanced to the 2nd tier subawardees N/A be recorded as expenses? Yes (high) No (med, low) 5. How often will the 2nd tier subawardee’s A minimum of Monthly (low) financial information be submitted to the Every other Month (med) organization? Quarterly or less often(high) 6. What information will the 2nd tier subawardee No invoicing required. (high) be required to submit to the organization for Financial Invoice only. (med) payment? Disbursements & receipts listing with financial invoice. (low) Original or copies of paid invoices with financial invoice. (low) Comments: 2nd Tier subs Rating Total (max 12):

J. Cost Share 1. Does the organization have policies and N/A procedures for documenting and monitoring Yes (low) cost share? No (med, high), explain

Comments: Cost Share Rating Total (max 2):

K. Satellite Offices 1. Will accounting transactions related to the FHI No (low) 360 funded project be recorded at the Yes (med, high), explain organization’s satellite offices?

2. Does the organization perform a monthly N/A financial review of the satellite offices’ Yes (low) supporting documentation? No (med, high), explain

3. Are financial duties in the satellite offices N/A separated so that no one individual has Yes (low) complete control over an entire financial transaction? No (med, high), explain

Comments: Satellite Offices Rating Total (max 6):

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater than US$150,000 (January 14, 2016) 12 | P a g e RATING & DETERMINATION FORM

Rating: RATE THE ORGANIZATION AS EXTREMELY HIGH, HIGH, MEDIUM OR LOW RISK BASED UPON THE FINANCIAL PRE-AWARD RESULTS. Assessment Section Organization Maximum Rating Rating A. General Organization Information 6 B. Internal Audits and Financial Statements 6 C. Financial Management

 Banking (Q# 1-2) 4

 Funding (Q# 3-4) 2

 Accounting Staff (Q# 5-7) 4

 Accounting System (Q# 8-13) 12

 Segregation of Duties (Q# 14-15) 4

 Documentation (Q# 16-20) 10

 Payroll (Q# 21-29) 18

 Petty Cash (Q# 30-31) 4

 Financial Reports & Budgets (Q# 32-35) 8

 Travel and Workshops (Q# 36-38) 6

D. Procurement, Property and Commodities Management Systems 22 E. Reports and Records 8 F. Insurance 2 G. Indirect Rate 2 H. Shared Cost Allocation Plan 2 I. 2nd Tier subs 12 J. Cost Share 2 K. Satellite Offices 6 Total: (a) (b) 140 . Enter the total number of “N/A” assigned to any PAT questions: (c ) Multiply by 2 and enter the results beside (c). . Subtract (c) from (b) and enter the results beside (d). (d) . Divide (a) by (d). Enter the results beside (e). This is the Overall (e) % Final Rating. Check the appropriate risk box. Overall Final Rating: Low Risk: 0-29% Medium Risk: 30-59% High Risk: 60-89%1 Extremely High Risk: 90-100%1 1Recommend not to issue the subaward; or obtain approval signature of the GBU/SBU Director and develop controls to address identified risks.

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 13 | P a g e RECOMMENDATION: SELECT OPTION 1 OR 2.

Option 1: Proceed with the subaward with the following Special Award Conditions and SFR/Invoice Supporting Documentation Requirements:

Special Award Conditions For any responses to individual PAT questions resulting in a “med=1” or “high=2”risk rating, and as deemed necessary, draft special award conditions in the space provided below. Recommend that these special awards conditions be incorporated in the subaward agreement; if no recommendations, state “none”. 1: Completion Date:

2: Completion Date:

3: Completion Date:

4: Completion Date:

5: Completion Date:

SFR/Invoice documentation requirements In the space below, describes the invoice and supporting documentation requirements for the proposed subaward. For cost reimbursable subawards, refer to Table 1 of the “FHI 360 Subaward Expenditure Documentation Guidance”, and the PAT assigned overall risked rating (low, medium, high or extremely high) to determine the minimum required documentation. For Help: Contact FHI 360 Operations Management at [email protected] . 1: Completion Date:

Option 2: Do not proceed with the subaward.

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 14 | P a g e PERSONS CONTACTED: Persons Contacted at the Organization: Name Position Title Contact Details (email or telephone)

CERTIFICATION: A minimum of three signatures are required; a conductor (FHI 360 or organization’s staff), reviewer and approver must sign below.

GENERAL CERTIFICATIONS

Assessment Conducted by FHI 360 staff (Business Unit Finance, Country Office Finance, Project Embedded Finance or Field Finance): Print Name Date Position Title Signature By signing this document I acknowledge that I have conducted the assessment in a prudent manner. Or Assessment Conducted by Organization’s staff (Organization’s Sr. Financial Representative Signature)** : Only required when it is impractical for FHI 360 to complete the assessment and the organization’s completes the assessment themselves.

Print Name Date Position Title Signature By signing this document I attest that I have answered the questions truthfully. I acknowledge that untruthful answers may have a negative impact on the awarding of the proposed subawards. **FHI 360 must document the reason why it was impractical for FHI 360 staff to complete the assessment questions: And Assessment Reviewed by FHI 360 staff (Senior Project Finance, Senior Country Office Finance, Senior Project Embedded Finance, Senior Field Finance or Geographic or Sector Business Unit Manager): Print Name Date Position Title Signature By signing this document I acknowledge that I have reviewed the responses and ratings and where necessary I have made further inquiries. I agree with the overall rating. And Assessment Approved by FHI 360 staff (Project Director, Chief of Party or Country Director): Print Name Date Position Title Signature By signing this document I acknowledge that I have reviewed the responses and ratings and where necessary I have made further inquiries. I agree with the overall rating.

Upon completion, scan and email signed completed PAT to [email protected]. This requirement is MANDATORY. Be sure to copy the CMS’s PMT or local Grant Administrator who worked with the project staff on the proposed subaward.

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 15 | P a g e SPECIAL CERTIFICATIONS

FHI 360 RO/BU/PPM Director’s Approval: Only required when Project Director, COP or Country Director desires to proceed with the issuance of a proposed subaward and the organization’s PAT determined overall final risk rating is “high” or “extremely high”. RO/BU/PPM Director’s Signature Date By signing this document I acknowledge that I am aware that based upon the completed PAT, the organization’s overall final risk rating is “high” or “extremely high”. My signature gives permission for the project staff to request the issuance of the subaward agreement. I am aware of the identified risk(s) and to help limit FHI 360’s exposure to such, necessary controls must be implemented by FHI 360 and the organization; these controls are described in the special award conditions section indicated above. I am aware that monitoring the adherence to these special conditions is extremely important, and procedures must be put into place to ensure that controls are implemented completely and in a timely manner.

DISTRIBUTION AND VENDOR SET UP DETAILS:

PAT Repository Submissions:

 Required: Scan and email signed completed PAT to [email protected] . This requirement is MANDATORY. Be sure to copy the CMS’s PMT or local Grant Administrator who worked with the project staff on the proposed subaward.

 Optional: Any other assessment supporting documentation that the project management staff wishes to be upload to the PAT Repository. These submissions are at the discretion of the project management staff and will not be verified or requested by the PAT Repository custodians. However, all documents submitted by the project to the repository will be uploaded and accessible.

The original completed PAT and all supporting documentation should remain with the project’s files.

Copy to Project and Technical Staff as appropriate Identify:

For awarded subawards, provide the local or HQ purchasing department with all needed vendor setup information. For subawards that will be paid from HQ, complete and submit the FHI 360 vendor/contractor certification form.

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 16 | P a g e Attachment A: Listing of information that may be requested of the applicant organization for the Financial Pre-Award Assessment.

Instructions: This document serves as an early notification of financial information that may be required of the applicant organization in the event that a FHI 360 Financial Pre-Award assessment is conducted. This document should be shared with the organization as soon as possible to alert them of FHI 360 Financial Pre-Award assessment process. 1. FINANCIAL DOCUMENTATION TO OBTAIN FROM THE APPLICANT ORGANIZATION (AS APPLICABLE) Copy of proposed subaward detailed budget, if available.

"Balance Sheet" and "Revenue and Expense Statement" for the prior 3 fiscal years.

Financial & Administrative Policies and Procedures Manual.

 Written policy to support fringe benefits (leave, medical, pension and other benefits)

 Written travel policy that addresses meals, accommodations, fuel, mileage, and other related travel cost

 Written procurement policy Negotiated Indirect Cost Rate Agreement (NICRA) or Audited Indirect Rate.

Shared cost allocation plan.

Description of the General Ledger Chart of Accounts major categories.

Cost sharing (matching) plan for applicable US Gov’t funders.

Example of a completed time sheet.

Incorporation papers, certificate of registration or Tax ID Number (TIN).

Support for tax exemption status.

Organizational chart or organogram emphasizing the organization’s finance and administration unit - Highlight the department/person that will be directly responsible for the implementation of the project and/or highlight satellite offices that will be involved in the implementation of the project. Sub Subawardee (2nd Tier) pre-award assessment and monitoring plans.

Satellite offices reporting requirements, reviews and sub-subawardee monitoring procedures.

Satellite Offices contact details.

Number of Satellite Office Name & Location that will be dedicated finance Estimated percentage or amount of involved in this project staff on site proposal budget managed by each office

a. Determine if the applicant organization is a recipient of funds from other U.S. organizations. If yes, obtain the following information about the U.S. organization:  U.S. organization’s name  Contact’s name and title  Address  Telephone and fax numbers

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 17 | P a g e  E-mail address

FHI 360 Financial Pre-Award Assessment of Organizations for Proposed Subawards Greater Than US$150,000 (January 14, 2016) 18 | P a g e