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

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

Financial Pre-Award AssessmentofOrganizationsforProposed Subawards Greater ThanUS$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.

Atthe pre-awards conclusion, observations of the organization’s financial systems are summarized and arecommendation is made. The results of the performance of the financial pre-award assessment are included in FHI 360’s Memorandum of Negotiationdocument. 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 . This requirementisMANDATORY. 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 HasFinancial Conflict of Interest Policyas applicable to U.S. PHS agencies’ funding.E.g. NIH,CDC, AHRQ.
Organization Type / Not for Profit or Nongovernmental
Governmental
Other: / University
For Profit
Proposed Subaward Details
Project Title
FHI 360 COMPASS Project Number (min 12 digits) / Operations Unit
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)
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 . 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.
A. General Organization Information / For all sections: 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. / Risk Rating:
N/A=0
Low=0
Med-1
High=2
To be completed by FHI 360 designated finance staff Only

1. Is the organization incorporated or legally registered?

/ Yes (low) Provide registration number:
No (med, high), explain

1. City and country of incorporation or legal registration:

/ No Rating

1. Date of incorporation or legal registration:

/ No Rating

1. For the current period, have the financial reporting and audit requirements associated with the registration been fulfilled? If no, what is pending?

/ N/A
Yes (low)
No (med, high), explain

1. Is the organization tax exempt for Value Added Tax (VAT) or Goods and Service Tax (GST)?

/ N/A
Yes (low)
No (med, high), explain if an alternative option is available:

1. Please list the number of employees of the organization:

/ Full-time employees
Part-time employees / No Rating

1. Enter the organization’s fiscal year:

/ No Rating
Comments:
General Organization Information Rating Total (max 6):
B. Internal Audits and Financial Statements

1. Has the organization undergone an internal financial audit or review duringthe current orprior fiscal year?

/ If no internal audit =(high)
Yes (med, low)
No ( high)

1. Review the Statement of Financial Position (Balance Sheet/Statement of Net Assets). Are the current assets minus the current liabilities positive?

/ If no Statement of Financial Position =(high)
Yes (low)
No (med/high)

1. Review the Statement of Financial Position (Balance Sheet/Statement of Net Assets). Does the organization have a positive “Unrestricted Net Assets”?

/ If no Statement of Financial Position =(high)
Yes (low)
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 kept in a bank account?

/ Yes (low) Name of the organization’s bank?
No (med, high), explain

1. If FHI 360 anticipates providing an advance of USG funds to the organization; does local practice and regulations permit the organization to open an interest bearing bank account? (Refer to 2 CFR 200.305(b) (8), and USAIDADS 303, and other applicable regulations.) – See QuestionC9 and C10 to determine if this will be a special award condition for the sub-awardee

/ N/A
Yes (low)
No (med, high)
Funding

1. Has the organization receivedfunding similar to the proposed subaward (U.S. Government, xyz foundation etc.) in the last 3 years? Recommended to request award letter/document.

/ No (med, high)
Yes (med, low)
Please identify the source and specify the amount(s) received from each source, by year below:
Source / Amount / Yr(s)

1. Based on the organization’s current year fiscal budget, list the organization’s expected sources and planned receipts for the current fiscal year. Identify the prime funder (U.S. Government, xyz foundation etc).

/ Source / Current Fiscal Year Planned Receipts / Prime Funder
/ No Rating
Accounting Staff

1. How many employees are in the Accounting Department and what are their names and key responsibilities?

/ Number of Staff in Accounting Dept.
Name / Key Responsibilities
/ No Rating

1. What is the background (work and education qualifications) of the Accountant for the project?

/ Work and education qualifications
(low, med, high risk depending on work and education qualifications)

1. Is it necessary to train the accountant prior to the implementation of the project?

/ No (low)
Yes (med, high), explain
Accounting System

1. Is the accounting system manual or automated? If automated, what is the accounting software program used? Specify.

/ No system (high)
Manual (med)
Automated (low, med)
Accounting Software System:

1. Is the accounting system capable of tracking and documenting the receipts of awarded funds by source (funder/award)?

/ Yes (low)
No (med, high), explain

1. Is the accounting system capable of tracking and documenting the utilization of awarded funds by source (funder/award)?

/ Yes (low)
No (med, high), explain

1. Does the organization use a written chart of accounts containing a description of each account?

/ Yes (low)
No (med, high), explain

1. Does the organization have writtenaccounting policies and procedures?

/ Yes (low, med)
No (high)

1. What accounting records are kept? (Indicate date of last entry.)

/ Yes /No / Date of last entry

1. General ledger

/ Yes
No

1. Cash receipts ledger

/ Yes
No

1. Cash disbursements ledger

/ Yes
No

1. Bank book

/ Yes
No

1. Petty cash book

/ Yes
No

1. Payroll register

/ Yes
No

1. Fixed Asset register

/ Yes
No

1. Advance Ledger

/ Yes
No
Segregation of Duties

1. Are there adequate segregation of duties between preparer, reviewer and approver for payments?

/ Yes (low)
Preparer (name/title/position):
Reviewer (name/title/position):
Approver (name/title/position):
No (med, high), explain
______

1. Is it the policy and practice that four different persons:

• prepare checks/EFT/internet banking, and
• authorize the payments, and
• reconcile bank accounts, and
• have access to receipts?

/ Yes (low)
No (med, high), explain
Documentation

1. Are pre-numbered forms used to record all of the financial transactions and account for the sequence of all numbers used?

/ Yes (low)
No (med, high), explain

1. Are key records matched before a transaction is approved (i.e., matching purchase order, receiving report, and vendor invoice before the invoice is approved for payment)?

/ Yes (low)
No (med, high), explain

1. Are copies of proof of payment (e.g.checks, EFTs, internet banking) attached to the payment voucher?

/ Yes (low)
No (med, high), explain

1. Are the source documents canceled (e.g.stamped “PAID”) after processing to provide 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)?

/ Yes (low)
No (med, high), explain

1. Will the supporting documentation (e.g. invoices, vouchers, time sheet hours) related to the FHI 360 project be maintained separately, marked, or coded so that that the cost therein are clearly distinguishable from non-FHI 360 projects?

/ Yes (low)
No (med, high), explain
If yes, indicate how: :
Payroll

1. Is each employee’s salary documented in an employment letter or contract?

/ Yes (low)
No (med, high), explain

1. Is a personnel action (or similar) form used to document salary revisions?

/ Yes (low)
No (med, high), explain

1. For new hires, does the organization have written policies and a salary scale to guide them in establishing new hires salaries?

/ Yes (low)
No (med, high), explain

1. Provide an example of an employee’s completed time sheet, if applicable.

/ N/A
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

1. Does the time sheet detail the employee’s hours worked each day by project (i.e., FHI 360 hours worked and non FHI 360 hours)?

/ N/A
Yes (low)
No (med, high), explain

1. Does the organization use the employee’s approved time sheets to allocate payroll?

/ N/A
Yes (low)
No (med, high), explain

1. Is the organization complying with government payroll tax withholding regulations? If not, explain.

/ N/A
Yes (low)
No (med, high), explain

1. Does the organization have a written policy to support fringe benefits (leave, medical, pension and other benefits)?

/ N/A
Yes (low), describe
No(med, high), explain

1. Does the organization have written policies and procedures that govern the conduct of ethics and conflicts of interest?

/ Yes (low)
No (med, high)
Petty Cash

1. Does the organization maintain petty cash on the imprest system?

/ N/A
Yes (low) What is the imprest petty cash amount: ______
No (med, high), explain

1. Does the organization have a written petty cash policy that addressespetty cash management andsegregation of such duties(e.g. Who keeps the petty cash? What expenses are paid and what documentation is obtained to support the expense)?

/ N/A
Yes (low)
No (med, high), explain
Financial Reports and Budgets

1. Are the financial statements/reports prepared by authorized personnel having sufficient experience and expertise to ensure compliance with applicable accounting principles?

/ Yes (low)
Preparer’s Name & Title:
No (med, high), explain

1. How frequent does the organization prepare financial statements/reports?

/ Monthly (low)
Quarterly (med)
Annually (high)

1. Are financial monitoring systems in place to ensure that budgets are not exceeded (i.e. costs compared with approved budgets and variances explained)?

/ Yes (low)
No (med, high), explain

1. Does the organization input funders’ budgets into the accounting systems by line item amounts,by total budget or neither?

/ Line item amounts (low)
Major cost categories (low, med)
Total (high)
Neither (high)
Travel and Workshops

1. Does the organization have a written travel policy that addresses meals, accommodations, fuel, mileage, and other related travel cost?

/ Yes (low)
No (med, high), explain

1. For meetings and workshops is there a written policy that describes adequate supporting documentation for participant’s expenses and attendance records?

/ N/A
Yes (low)
No (med, high), explain

1. Does the organization have a system to track advances (e.g. travel, workshops)they issue to ensure that they are appropriately accounted for and documented? How is the difference in the amount advanced and actually paid resolved?

/ N/A
Yes (low)
No (med, high), explain
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 procurement policy?

/ Yes (low)
No (med, high), explain

1. Does the organization always solicit quotations from vendors before making a purchase over the local currency equivalent of $3,000 (organization may have more restrictive policy)?

/ Yes (low)
No (med, high), explain

1. When dealing with US government funded projects, are terrorism and debarment searches performed of potential vendors, employees, consultants and subrecipients?

/ N/A
Yes (low)
No (med, high), explain

1. Are secured facilities used when appropriate, and access to equipment and commodities limited to authorized personnel?

/ Yes (low)
No (med, high), explain

1. Are the commodities maintained in a secure storage facility that meet the temperature and humidity requirements and are free from rodents, insects, oil and water damage?

/ N/A
Yes (low)
No (med, high), explain

1. Does the organization use inventory stock cardsto manage commodities and supplies?

/ Yes (low)
No (med, high), explain

1. Does the organization have adequate controls to ensure that obsolete commodities are not distributed? (Commodities; such as medical supplies, pharmaceuticals, condoms and printed media materials, etc.)

/ N/A
Yes (low)
No (med, high), explain

1. Are different individuals responsible for purchasing goods, receiving goods, and approving vouchers?

/ Yes (low)
No (med, high), explain

1. Are incoming and outgoing assets counted, inspected, and received or released on the basis of proper authorization in accordance with established procedures?

/ Yes (low)
No (med, high), explain

1. Does the organization maintain a fixed asset listing of non-expendable property containing the following? (Description, serial number, acquisition cost, acquisition date, unique fixed asset number assigned by the organization, location, current condition, and funding source.)

/ Yes (low)
No (med, high), explain

1. Are assets on hand periodically (at least yearly) inspected and counted, and the results compared with the asset records?

/ Yes (low)
No (med, high), explain
Comments:
Procurement , Property and Commodities Management Systems Rating Total (max 22):
E. Reports and Records

1. Are secured facilities used when appropriate, and access to critical forms and equipment limited to authorized personnel?

/ Yes (low)
No (med, high), explain

1. Is access to computer programs and data files restricted to authorized personnel only?

/ Yes (low)
No (med, high), explain

1. Are procedures in place to providereasonable assurance that current files can be recovered in the event of a computer failure?

/ Yes (low)
No (med, high), explain

1. Does the organization retain accounting records, including invoices, vouchers and time 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.)

/ Yes (low)
No (med, high), explain
Comments:
Reports and Records Rating Total (max 8):
F. Insurance

1. Does the organization maintain Property, General Liability or Other types of insurance? If yes, copies of current insurance certifications (or insurance policy) should be available for review as applicable to the project. Consider the project/prime funders requirements.

/ Property/Vehicle Insurance: Yes (low)
No (med, high)
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, overhead, or administrative rate, such as an approved US Government negotiated indirect cost rate (NICRA)?

/ N/A
Approved NICRA Rate (low)
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 the organization use a shared cost allocation plan, to allocate direct cost such as; rent, utilities, administrative supplies, consistently and equitably between all funders?

/ N/A
Yes (low)
No cost allocation plan (med, high), explain
Comments:
Shared Cost Allocation Plan Rating Total (max 2):
I. 2nd Tier subs

1. Does the organization have a financial pre-award questionnaire/process in which it administers to 2nd Tier-subawardees?

/ N/A
Yes (low)
No (med, high), explain

1. Does the organization have written policies and procedures for monitoring 2nd tier subawardees?

/ N/A
Yes (low)
No (med, high), explain

1. Will each 2nd tier subawardee’s expenses be easily identifiable in the organization’s financial accounting reports?

/ N/A
Yes (low)
No (med, high), explain

1. Will funds advanced to the 2nd tier subawardees be recorded as expenses?

/ N/A
Yes (high)
No (med, low)

1. How often will the 2nd tier subawardee’s financial information be submitted to the organization?

/ A minimum of Monthly (low)
Every other Month (med)
Quarterly or less often(high)

1. What information will the 2nd tier subawardee be required to submit to the organization for payment?

/ No invoicing required. (high)
Financial Invoice only. (med)
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 procedures for documenting and monitoring cost share?

/ N/A
Yes (low)
No (med, high), explain
Comments:
Cost Share Rating Total (max 2):
K. Satellite Offices

1. Will accounting transactions related to the FHI 360 funded project be recorded at the organization’s satellite offices?

/ No (low)
Yes (med, high), explain

1. Does the organization perform a monthly financial review of the satellite offices’ supporting documentation?

/ N/A
Yes (low)
No (med, high), explain

1. Are financial duties in the satellite offices separated so that no one individual has complete control over an entire financial transaction?

/ N/A
Yes (low)
No (med, high), explain
Comments:
Satellite Offices Rating Total (max 6):

FHI 360 Financial Pre-Award Assessmentof Organizations for Proposed Subawards Greater than US$150,000