HomeMy WebLinkAboutSH18-050 FFY18 HSGP - Audit Certification2 CFR Part 200 Subpart F Audit Certification Form
Audits of States, Local Governments, Indian Tribes, and Non-Profit Organizations
Contact Information
Subrecipient Name (Agency, Local Government, or Organization):
Authorized Chief Financial Officer (central accounting office):
Address:
Email: Phone #:
Purpose: As a pass-through entity of federal grant funds, the Washington Military Department/Emergency Management Division (Department)
is required by 2 CFR Part 200 Subpart F to monitor activities of subrecipients to ensure federal awards are used for authorized purposes and
verify that subrecipients expending $750,000 or more in federal awards during their fiscal year have met the 2 CFR Part 200 Subpart F Audit
Requirements. Your entity is a subrecipient subject to such monitoring by MIL/EMD because it is a non-federal entity that expends federal grant
funds received from the Department as a pass-through entity to carry out a federal program. 2 CFR Part 200 Subpart F should be consulted
when completing this form.
Directions: As required by 2 CFR Part 200 Subpart F, non-federal entities that expend $750,000 in federal awards in a fiscal year shall have
a single or program-specific audit conducted for that year. If your entity is not subject to these requirements, you must complete Section A of
this Form. If your entity is subject to these requirements, you must complete Section B of this form. When completed, you must sign, date,
and return this form with your grant agreement and every fiscal year thereafter until the grant agreement is closed. Failure to return this
completed Audit Certification Form may result in delay of grant agreement processing, withholding of federal awards or disallowance of costs,
and suspension or termination of federal awards.
SECTION A: Entities NOT subject to the audit requirements of 2 CFR Part 200 Subpart F
Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F because (check all that apply):
We did not expend $750,000 or more of total federal awards during the fiscal year.
We are a for-profit agency.
We are exempt for other reasons (describe):
However, by signing below, I agree that we are still subject to the audit requirements, laws and regulations governing the program(s) in
which we participate, that we are required to maintain records of federal funding and to provide access to such records by federal and state
agencies and their designees, and that WMD/EMD may request and be provided access to additional information and/or documentation to
ensure proper stewardship of federal funds.
SECTION B: Entities that ARE subject to the audit requirements of 2 CFR Part 200 Subpart F
(Complete the information below and check the appropriate box)
We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] ________ for Fiscal Year ending [enter date] ________. There
were no findings related to federal awards from WMD/EMD. No follow-up action is required by WMD/EMD as the pass-through entity.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is
either provided electronically to contracts.office@mil.wa.gov or provide the state auditor report number:
___________________.
We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] ________ for Fiscal Year ending [enter date] ________. There
were findings related to federal awards.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is either
provided electronically to contracts.office@mil.wa.gov or provide the state auditor report number: ______________________.
Our completed 2 CFR Part 200 Subpart F Audit will be available on ________ [enter date] for Fiscal Year ending
________[enter date]. We will provide electronic copy of the audit report to contracts.office@mil.wa.gov at that time or
provide the state auditor report number: ________________________.
I hereby certify that I am an individual authorized by the above identified entity to complete this form. Further, I certify that the
above information is true and correct and all relevant material findings contained in audit report/statement have been disclosed.
Additionally, I understand this Form is to be submitted every fiscal year for which this entity is a subrecipient of federal award
funds from the Department until the grant agreement is closed.
Signature of Authorized Chief Financial Officer: Date:
Print Name & Title:
WMD Form 1009-13, 8/19/2013, Updated 9/9/2015