FINANCIAL QUESTIONNAIRE

Grant Recipient Risk Assessment Questionnaire

The purpose of this questionnaire is to provide the City Of Reading (COR) with information needed to assess the adequacy of your organization’s accounting policies and procedures and grants management practices.

Prior to any grant award, COR must be assured that the proposed grantee has sound financial controls and reporting systems to ensure that all COR funds are expended prudently and accounted for appropriately. COR must also be assured that the proposed grantee institution is able and willing to comply, and (as applicable) is able and willing to ensure compliance by any sub-grantees, with COR policies, applicable donor terms and conditions, and local laws and regulations. COR may condition funding on the implementation of certain practices or improvements.

Each question should be answered as completely as possible. There is a glossary at the end of this form if you need help with some of the financial terms. It is very important that the questionnaire is signed by the organization’s head and most senior financial manager (see section G). If you are submitting this questionnaire electronically, please include a scanned copy of the signature page or fax the signature page.

All information submitted to COR in this form and through the requested attachments will be treated as confidential and will not be disclosed to any third parties, unless required by law.
CONTACT INFORMATION
Organization Name:*
(legal name of organization that will sign the agreement and accept responsibility for COR’s funds, if awarded)
Web Address
Street Address*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Director/President
Project Manager
Financial Officer
(will be responsible for authorizing financial transactions and reports for this project)
Project Accountant
(will be responsible for authorizing financialtransactions and reports for this project)
YESNO
If "YES" Please explain
Proposed Grant Amount: *
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
1. Number of Paid Employees:*
Full Time:
Part Time:
SECTION A: General Background Information
NGO/Not-for-profit organizationFor-profit/commercial enterpriseIndividualGovernment OrganizationState-owned UniversityParastatal AgencyPrivate UniversityOther
If Other
Non-US, Tax-exemptFor-profit/commercial enterpriseIndividualGovernment OrganizationState-owned UniversityParastatal AgencyPrivate University
If Other
Non-US, Tax-exemptUS, Tax-exempt, 509 (a) (1)Non-US, TaxableUS, TaxableUS, Tax-exempt, 501 (c) (3)
If Other
4.Please indicate your Tax Identification Number (for non-US organizations) oryour Employer Identification Number (for US organizations):@font-face *
5. Beginning and ending dates of your organization's fiscal (financial) year:
Beginning Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
6. Total Budget for most recent fiscal year:
Revenues(including grants): USD*
Expenses: USD*
US GovernmentDomestic GovernmentOther GovernmentsFoundations/Corporations/IndividualsSale of Goods/ServicesMembership Fees
YESNO
YESNO
If Yes, please explain
YESNO
If yes, please provide the person’s name and project title.

11. Has the organization received grants from other organizations? If so, please provide details of the 3 most recent awards including name of grantor, source of funds, amount, period covered, and project manager and financial officer.

Rows	Project Title	USD Grant Amount	Grant/Donor
1
2
3

Rows	Grant Period	US Gov't Funds?	Project Manager	Financial Officer
1
2
3

12. Does the organization expect to receive other grants during the proposal period of this project? If so, list the organizations that have your proposals under review and the tiles of the projects submitted for their review:

Rows	Project Title	USD Amount	Project Manager	Financial Officer
1
2
3

SECTION B: Internal Controls
Internal controls are procedures which ensure that: 1) financial transactions are approved by an authorized individual and follow laws, regulations, and the organization's policies, 2) assets are kept safely, and 3) accounting records are complete, accurate and kept on a regular basis. Please complete the following questions concerning your organization's internal controls:
1. Indicate which of the internal controls listed below are in place at your institution:

a. Documented competitive system of procurement for major purchases (e.g., if your organization plans to acquire new equipment, it requests written bids from at least three (3) vendors):
Name *
Title*
YESNO
c. Physical Control over assets
YESNO
YESNO
YESNO
YESNO
Other (Please Specify)
2. If a grant were awarded for this project, who would be responsible for:
a. requesting payments?
Name*
Title*
b. approving requests for payments?
Name*
Title*
c. issuing payments?
Name*
Title*
d. reconciling accounts?
Name*
Title*
e. preparing project financial reports?
Name*
Title*
f. approving project financial reports?
Name*
Title*
YESNO
once a weekonce a monthonce a quarteronce a year
Who reviews these reports?
Name*
Title*
YESNO
YESNO
In case of a grant award, the project employees will be required to document time spent on the project activities on a daily basis.
SECTION C: Accounting System

The purpose of an accounting system is to: 1) accurately record all financial transactions, and 2) ensure that all financial transactions are supported by invoices, timesheets, and other documentation. The type of accounting system often depends on the size of the organization. Some organizations may have computerized accounting systems, while others use a manual system to record each transaction in a ledger. In either case, COR grant funds must be properly authorized, used for the intended purpose and recorded in an organized and regular manner.
YESNO
YESNO
If "Yes", please name accounting software package.
YESNO
In case of a grant award, your organization will be required to track the grant receipts and expenditures separately from other organizational funds and other grants/contracts.
4. Does your accounting/financial procedures include budgetary controls to prevent incurring obligations greater than:
YESNO
YESNO
5. For how long does your organization maintain support documentation (receipts, invoices, purchase orders, etc.) for all transactions? *
YESNO
7. Does your organization utilize the accrual or cash method of accounting? *
SECTION D: Funds Control

COR grantees that receive advances of grant funds may deposit them in a bank account kept in local currency or U.S. dollars. COR normally pays grantees periodically by wire transfer of U.S. dollars to the grantee bank account. Access to the bank account must be limited to authorized individuals. Bank balances should be compared each month with your accounting records. If cash cannot be kept in a bank, it is very important to keep the cash in a strong safe and have strict controls over cash custody and disbursement.
YESNO
YESNO
YESNO
SECTION E: Independent Audit

COR may require an audit of your organization's accounting records. An audit is a review of your accounting records by an independent accountant who works for an accounting firm. An audit report contains your financial statements as well as an opinion by the accountant that your financial statements are correct. Please provide the following information on prior audits of your organization.
YESNO
If yes, who performs the audit?
QuarterlyYearlyEvery 2 years
Indicate when last audit was performed*

MonthDayYear
FinancialA-133Program
Other
SECTION F: Sub-grantee Policy

A sub-grant represents financial assistance in form of money, or property in lieu of money, made under the main award to another organization in order to achieve a defined scope of work.
YESNO
If yes, please answer the following questions. Otherwise, proceed to the next section.

2. Provide the number and size of the sub-agreements you plan to administer under the proposed grant.

Rows	Sub-grantee Name	USD Amount
1
2
3

YESNO
YESNO
YESNO
SECTION G: CERTIFICATION

The Accounting Questionnaire must be signed and dated by authorized personnel who have either completed or reviewed the form.

I certify to the best of my knowledge and belief that the information provided in this questionnaire and the supporting data are correct.
Director of Organization:
Print Name*
Title*
Signature*
Date*

MonthDayYear
Financial Officer:
Print Name*
Title*
Signature*
Date*

MonthDayYear
ATTACHMENTS

Please attach all of the following documents (where available) and any other information you deem relevant on the subjects listed above:

Materials that describe your organization, its mission and history

Incorporation or registration certificate

List of all the current members of the Board of Directors

IRS determination letter (for US organization)

Most recent financial statements (balance sheet and income statement)

Most recent independent auditor’s report and Management Letter (if available)

If answered “Yes” to Question #6 in Section A, please provide the following:

Explanation of the nature of occurrence (originating and current date, most recent statement: why incurred, methods on prospects of repayment, if any; any additional relevant information.)
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COR GLOSSARY OF TERMS

Accrual based accounting system: An accounting system where your financial report shows payments which have been made as well as invoices which have been received but not yet paid.

Actual cost: Any type of expense which has been paid for.

Allowable costs: Expenses which are for grant activities, and which are reasonable and legal.

Balance sheet: A report which lists your assets (income to be received, cash, equipment) and your liabilities (payments to be made).

Cash based accounting system: An accounting system where your financial report only shows payments which have been made.

Expenses/Expenditures: Costs charged to the grant.

Financial statement: A report containing your balance sheet, and revenue and expense statement.

Financial report: A report which shows the money which an organization has spent on the grant for the period, usually three months. COR requires a financial report for each three-month period (quarter).

Fiscal year: The financial year of your organization. Most fiscal years are from January 1 to December 31. Other fiscal years end on March 31, June 30, or September 30.

Funds: Money.

Grant: An award given to an organization to complete a project. COR grants are usually for one year.

Grantee: An organization which receives a grant.

Incurred cost: Any type of expense which has been made but not yet paid.

Internal controls: A system set up by an organization to make sure that money is received and spent in the correct manner.

Manual ledgers: Accounting records which are maintained by hand (without a computer) and which record similar transactions such as cash receipts, cash payments, salaries, inventory, etc.

Petty cash: Small amounts of cash used to pay small expenses (taxi, bus, office supplies).

Primary grantee: An organization which receives a grant and which in turn gives part of those funds to another organization to help complete the grant. Primary grantees are responsible for monitoring their subrecipients.

Income statement/statement of activities: A report which shows the money which your organization received (revenue) and how the money was spent (expense).

Subrecipient/Subgrantee/Subawardee: An organization which receives part of a grant given to another organization.

Subrecipient monitoring: What the primary grantee does to make sure that the subgrantee is correctly implementing the grant.

Separate bank account: A bank account in the name of your organization set up for your COR grant. Only COR funds are deposited into the account and only COR program expenses are paid from the account.

Unallowable costs: Expenses which are not related to the COR grant, which are unreasonable, and not accepted by law. These include but are not limited to alcohol (beer, wine, cocktails), cigarettes, fines, parking tickets, bribes, etc. and all expenses which are not approved in the COR grant budget.
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