Form SF-SAC Worksheet & Single Audit Component Checklist For Audits With Fiscal Periods Ending in 2010, 2011 and 2012

Enter and Submit Form SF-SAC data and Single Audit package only at:

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AUDIT COMPONENTS REQUIRED FOR SINGLE AUDIT SUBMISSION:

Single Audit Component Checklist

Attention: Please review your audit report to make sure that Personally Identifiable Information, or PII, is not included. Examples of PII are, but not limited to, Social Security Numbers, account numbers, vehicle identification numbers, copies of cancelled checks, student names, dates of birth, personal addresses or personal phone numbers. ___________________________________________________________________________________________

Please enter the starting pdf file page number for each of the following components. If auditor reports have been completed, then list the starting page number of the combined report for each corresponding report on the checklist. If a component is not required, enter 'N/A' instead of a page number. Each component on the checklist must have a numeric page number or 'N/A' listed.

The following is a key for the Component Checklist

* = Required (cannot be blank or 'N/A').

** = Required if prior audit findings exist.

*** = Required if findings exist.

Note: These codes do not apply to a program specific audit..

Page Number Component

* Financial Statement(s) §__ .310(a)

* Schedule of expenditures of Federal Awards §__ .310(b)

** Summary Schedule of Prior Audit Findings §__ .315(b)

* Opinion on Financial Statements §__ .505(a)

* A-133 Report on Internal Control §__ .505(b) (major programs)

* GAS Report on Internal Control §__ .505(b)

* A-133 Report on Compliance §__ .505(c) (major programs)

* GAS Report on Compliance §__ .505(c)

* Schedule of Findings and Questioned Costs §__ .505(d)

*** Corrective Action Plan (if findings) §__ .315(c)

* Opinion or Disclaimer of Opinion on Schedule of Federal Awards §__ .505(a

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U.S. DEPARTMENT OF COMMERCEEconomics and Statistics Administration

U.S. CENSUS BUREAUInstructions for Form SF-SAC,Reporting on Audits of States, Local Governments and Non-Profit Organizations

For Fiscal Periods Ending in2010, 2011 OR 2012

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of informationunless it displays a valid OMB control number. The valid OMB control number for this information collection is OMB No.0348-0057. The time required to complete this data collection form is estimated to average 59 hours for large auditees(i.e., auditees most likely to administer a large number of Federal awards) and 17 hours for all other auditees. Theseamounts reflect estimates of reporting burden on both auditees and auditors relating to the Form SF-SAC, including thetime to review instructions, obtain the needed data, and complete and review the information.

Circular A-133 §__. 320(b) requires auditees to submit acompleted Form SF-SAC, along with one completereporting package in accordance with the June 26, 2007Federal Register notice, to the Federal clearinghousedesignated by OMB (currently the U. S. Census Bureau).The reporting package is defined in §__. 320(c) of the Circular.Auditees are also required to send a copy of the reportingpackage (or written notification of no findings) (§__. 320(e)) toany pass-through entity from which they receive Federal funds.Submissions to a pass-through entity should not include theForm SF-SAC.

Auditees should not submit a reporting package or FormSF-SAC if their A-133 audit report is included in anotherauditee’s report. Example: If the audit of a state university’sFederal awards is included in the statewide single audit reportand Form SF-SAC, the university should not submit a reportingpackage or Form SF-SAC to the Federal clearinghouse.

This Form SF-SAC version, dated 04-15-2010 should beused for audits covering fiscal periods ending in 2010,2011 and 2012. This Form is only available for submissionon the Federal Audit Clearinghouse (FAC) Web site(http://harvester.census.gov/fac/). Submissions covering fiscalperiods with end dates prior to January 1, 2008 must use oneof the earlier versions of Form SF-SAC available on theFederal Audit Clearinghouse (FAC) Web site(http://harvester.census.gov/fac/). The form dated 8-6-2008must be used for audits covering 2008 and 2009. The formdated 5-2004 must be used for audits covering fiscal periodsending in 2004, 2005, 2006 or 2007. The form dated 3-20-2001must be used for audits covering fiscal periods ending in 2001,2002 or 2003.

Audit threshold for Federal expenditures is $500,000 ormore per year. Beginning with 2004 audit year submissions,the Office of Management and Budget (OMB) Circular A-133(Circular), “Audits of States, Local Governments, and Non-ProfitOrganizations,” requires non-Federal entities that expend$500,000 or more in a year in Federal awards to have an auditconducted in accordance with the Circular. For prior audit years,1997-2003, the audit threshold for Federal expenditures is$300,000 or more per year.

SUBMISSION TO THE FEDERAL AUDITCLEARINGHOUSE – Auditees are required to use theon-line Internet submission option available on theFAC Web site. The only approved Form SF-SAC format is aform created using the on-line Internet Data Entry Systemoption on the FAC web site. The FAC Web site is located at:http://harvester.census.gov/fac/. Click the appropriate link forForm SF-SAC options.

ELECTRONIC FORM INSTRUCTIONS – Beginning withaudits with Fiscal periods ending in 2008, all Form SF-SAC andAudit submissions must be made on the Internet. Both theauditor’s and auditee’s email addresses must be used tocreate a Form SF-SAC, attach the Single Audit and to createthe electronic certifications and signatures. Further instructionsare available on-line. Begin the Form SF-SAC athttp://harvester.census.gov/fac/collect/ddeindex.html.

Spreadsheet files for reporting the multiple Employer Identification Numbers (EINs), multiple Data UniversalNumbering System (DUNS) numbers, Federal awards andaudit finding data can be uploaded into the on-line InternetData Entry System.

Prior to completing Form SF-SAC on-line, review thestep-by-step instructions available on the FAC Web site.Auditees must enter their Form SF-SAC data using the InternetData Entry System. After the form passes all edits, anelectronic image file containing the reporting package must beattached. Submit and sign the Form with electronic signatures.Submission of anything other than a completed form andreporting package will not be accepted.

Revision – Submit audit revisions using the same report usedto create the initial form on-line. After logging into the originalreport, follow the revision instructions on the main menu.

Form Due Date: The audit shall be completed and the datacollection form and reporting package shall be electro-nically transmitted within the earlier of 30 days after receipt ofthe auditor’s report(s), or nine months after the end of theaudit period, unless a longer period is agreed to in advance bythe Federal cognizant or oversight agency for audit.

The SF-SAC is not to be used by commercial (for profit) ornon-United States auditees. Commercial (for profit) andforeign organizations should see the Federal awarding agencycontact for audit report submission instructions.

WHAT’S NEW:

Reporting of American Recovery and Reinvestment Actof 2009 (ARRA) expenditures. Expenditures occurring infiscal years ending in 2010, 2011 and 2012 must be identified asRecovery or Non-Recovery Act funds. A new column has beenadded to Page 3 Item 9 that will identify these expenditures. If aCFDA program involves the expenditure(s) of both RecoveryAct and non-Recovery Act funding, each must be listed on aseparate line.

WHO TO CONTACT WITH QUESTIONSFor questions related to specific Federal awards, pleasecontact the Federal agency from which the award originated.For technical audit questions, please contact the auditee’sFederal cognizant or oversight agency. Appendix III of the“OMB Circular A-133 Compliance Supplement” containsFederal agency contact information for A-133 audits. AppendixIII of the Compliance Supplement is accessible via the Internetat www.whitehouse.gov/OMB/grants. For questions concerningthe submission process or the form, contact the FAC(1.800.253.0696). Information can also be found on the FACWeb site (http://harvester.census.gov/fac/).

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Note: Instructions for uploading additional EINs areincluded in the on-line instructions available on the FACWeb site.

(d) Data Universal Numbering System (DUNS) Number –The Data Universal Numbering System (DUNS) number isa unique nine-digit identification sequence assigned byDun & Bradstreet (D&B) (available from the D&B DUNSregistration hotline at 866-705-5711). A DUNS number isrequired when applying for a Federal grant on Grants.govor any other application method. All auditees who submita Form SF-SAC are requested, but not required to reportthe DUNS number on Part I, Item 4d, 4e, and 4f of theForm SF-SAC. For more information go tohttp://fedgov.dnb.com/webform.

If “Y” is marked, enter the DUNS numbers of thecomponent entities in Part I, Item 4(f). Part I, Item 4(f)must contain an entry other than the one entered in 4(d).If “N” is marked in 4(e), leave Part I, Item 4(f) blank.

Auditees who process Federal awards for componententities expending Federal awards should mark Item 5(e)“Yes” and list the DUNS numbers of the componententities in Part 5(f) on the continuation sheet on Page 4 ofthe Form.

(a-e) Enter auditee contact information. Department ofHousing and Urban Development project numbers areoptional, and may be included with the auditee name.

Note: Instructions for uploading additional DUNS areincluded in the on-line instructions available on theFAC Web site.

Example 1: Component Unit reporting: The SmithCounty Sheriff’s Office applied for and expended its ownFederal grants using its own DUNS number. However, theSmith County government Finance Office required theSheriff’s Office grants to be reported as a component ofSmith County’s Single Audit. Smith County should enterthe Smith County DUNS number as the principal DUNSnumber in Item 4(d), mark Item 4(e) “Y,” and enter theSmith County Sheriff’s Office DUNS number in Item 4(f).

(f) Enter a valid email address.

(g) A senior representative of the auditee (e.g., ChiefExecutive Officer, Controller, Director of Finance, ChiefFinancial Officer) signs the statement that theinformation on the form is accurate and complete asrequired by §__.320 of the Circular. Provide the printedname and title of the signatory and the date ofsignature.

(a) Primary Employer Identification Number (EIN) –Enter the Auditee’s Employer Identification Number (EIN),the nine-digit taxpayer identification number assigned bythe Internal Revenue Service (IRS). If the auditee wasassigned multiple EINs, enter the primary EIN. Also, usingthe spaces provided, enter the primary EIN on the top ofeach page of the form.

Item 2 – Type of Circular A-133 Audit – Mark (X) theappropriate box. ’__.200 of the Circular requires non-Federalentities that expend $500,000 or more in a year in Federalawards to have a single audit conducted in accordance with’__.500, except when they elect to have a program-specific auditconducted in accordance with ’__.235.

Item 3 – Audit Period Covered – Mark the appropriate box.Annual audits cover 12 months and biennial audits cover 24months. If the audit period covered is neither annual norbiennial, mark “Other” and provide the number of months(excluding 12 and 24) covered in the space provided.

Item 4 – Auditee Identification Numbers

(b) Are Multiple EINs Covered in this Report? Mark (X) theappropriate box to indicate if the auditee (or components ofan auditee covered by the audit) was assigned more thanone EIN by the IRS. (Example: A Statewide audit coversmany departments, each of which may have its own EIN.)

(c) List the multiple EINs covered in this report – If Part I,Item 4(b) is marked “Yes” list the additional EIN numbersfor all entities covered by the audit in Item 4(c). An EINshould be considered covered in this report if this report isintended to satisfy the entity’s or component’s (e.g., StateAgency, sub-entity) single audit requirement. Do notinclude separate EINs for any component that did notreceive, expend, or otherwise administer Federal awards.Do not include the primary EIN in Item 4(c) of thecontinuation list.

Item 5 – Auditee Information

Example 2: Non-component Unit reporting: TheJones County Sheriff’s Office applied for and expendedFederal grants using its own DUNS number. The JonesCounty Sheriff’s Office prepared and submitted anindependent Single audit. The Jones County Sheriff’sOffice should enter its DUNS number as the principalDUNS number in Item 4(d), and mark Item 4(e) “N.”

Example 3: Financial Administration: A StateUniversity system audit covers the Federal awardexpenditures of every campus in the system. EachUniversity or campus in the system applied for andexpended its own direct Federal grants using its ownDUNS number. The State Board of Education served onlyas a conduit for the disbursement of Federal awards toeach University and campus. The audit of the StateUniversity system should list the payee’s (State Board ofEducation) DUNS number as the primary DUNS numberin Item 4(d), mark Item 4(e) “Yes,” and list the DUNSnumbers for each campus listed in the original grantapplications in Item 4(f).

Note: Forms missing either a legible auditeesignature, date of signature, printed name or printedtitle will be rejected.

(f) List the multiple DUNS numbers covered in thisreport – If Part I, Item 4(e) is marked “Yes,” list theadditional DUNS numbers on Item 4(f) of the continuationsheet on page 4 of the Form SF-SAC. Report a DUNSnumber in Item 4(f) if it identifies a component entity(e.g., State Agency, sub-entity) of the auditee with Federalawards expended during the fiscal period included in theaudit. Do not include separate DUNS numbers for anycomponent entity that did not expend or otherwiseadminister Federal awards. The order of the DUNSlistings is not important.

DESCRIPTION OF FORM

PART I – GENERAL INFORMATION

The auditee completes this section (except Items 4 and 7) andsigns and dates the certification statement provided in Item6(g). The auditor completes Item 7 and signs and dates thestatement provided in Item 7(g).

Item 1 – Fiscal Period Ending Date For This Submission

Enter the last day of the fiscal period covered by the audit.The 2010 form applies to all audits covering fiscal periodsending in the 2010, 2011 or 2012 calendar years. The 2008Form applies to all audits covering fiscal periods ending in the2008 or 2009 calendar years.

(e) Are multiple DUNS numbers covered in this report?Mark (X) the appropriate “Y” for yes or “N” for No box toindicate if a component entity (e.g., State agency,sub-entity) expending Federal awards is covered in theaudit report.

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(g) The auditor listed in Part I, Item 6(a) is the same auditorthat signs the auditor statement.

Item 7 – Add Optional Secondary Auditor Information?

If secondary audit organizations were used to conduct theaudit work, and the primary auditor chooses to include contactinformation for the secondary auditors, mark (x) “Y” for yes.Otherwise, mark “N” for no.

Item 8 – Secondary Auditor Information (Optional)

(a-e) If Part I, Item 7 is marked “Y,” enter the name and con-tact information of the secondary auditor organization(s)used to conduct the audit work.

(f) Enter a valid email address.

Note: Only the primary auditor will sign the certificationstatement.

PART II – FINANCIAL STATEMENTS

The auditor completes this section of the form. All informationfor this section should be obtained from the opinion on thefinancial statements and reports in accordance with theGovernment Auditing Standards (GAS) related to the financialstatement audit.

Item 1 – Type of Audit Report. If the audit report for thefinancial statements as a whole is unqualified, mark box 1“Unqualified opinion.” If the audit report for the financialstatements is other than unqualified, mark box(es) 2 “Qualifiedopinion,” 3 “Adverse opinion,” and/or 4 “Disclaimer ofopinion,” as applicable.

Audits of state and local governments often result in theauditor providing multiple opinions on various opinion unitswithin the financial statements. In situations where there areunqualified opinions on some opinion units and modifiedopinions or disclaimers of opinions on others, multiple boxesshould be checked in response to this question. For example,if the financial statements for an auditee include a qualifiedopinion for one opinion unit, a disclaimer of opinion for asecond opinion unit, and unqualified opinion on the remainingopinion units, then mark boxes 2 and 4, but not 1 and 3. Box 1is only marked for an unqualified opinion on the financialstatements as a whole or when unqualified opinions areprovided on all opinion units.

Item 2 – Is a “going concern” explanatory paragraphincluded in the audit? Mark either “Y” for yes or “N” for noto indicate the existence of a “going concern” explanatoryparagraph in the audit report.

According to AICPA Audit Guide “Government AuditingStandards and Circular A-133 Audits”, if the audit of Federalawards did not encompass the entirety of the auditee’soperations expending Federal awards, the operations that arenot included should be identified in a separate paragraphfollowing the first paragraph of the report on major programs.In Part III, Item 1, mark either “Yes” or “No” to indicate thepresence of such a paragraph for any departments, agencies,or other organizational units not included in the audit, whichexpended $500,000, or more in Federal awards during the fiscalperiod.

Item 2 – What is the dollar threshold to distinguish TypeA and Type B programs? Enter the dollar threshold used todistinguish between Type A and Type B programs as definedin ’__.520(b) of the Circular. The dollar threshold must be$300,000 or higher. Round to the nearest dollar.

Item 3 – Did the auditee qualify as a low-risk auditee?Mark either “Y” for yes or “N” for no to indicate if the auditeequalifies as a low-risk auditee under ’__.530 of the Circular.

Item 4 – Is a significant deficiency disclosed for anymajor program? Mark either “Y” for yes or “N” for no toindicate if the Schedule of Findings and Questioned Costsinclude any significant deficiencies in internal control for majorprograms (Circular ’__.510 (a)(1)).

Item 5 – Is any significant deficiency reported for anymajor program as a material weakness? If Item 4 is marked“N,” skip Item 5. If Item 4 is marked “Y,” mark Item 5 either“Y” or “N” to indicate if any significant deficiencies included inthe Schedule of Findings and Questioned Costs are materialweaknesses (Circular ’__.510 (a)(1)).

Item 6 – Are any known questioned costs reported? Markeither “Y” for yes or “N” for no to indicate if the Schedule ofFindings and Questioned Costs discloses any knownquestioned costs (Circular ’__.510 (a) (3) or (4)).

Item 7 – Were Prior Audit Findings related to directfunding shown in the Summary Schedule of Prior AuditFindings? Mark either “Y” for yes or “N” for no to indicate ifthe Summary Schedule of Prior Audit Findings reports thestatus of any audit findings relating to direct Federal awardsexpended. If “Y”, identify the Federal agency (ies) with priordirect findings in Part III, Item 8.

Item 3 – Is a significant deficiency disclosed? Mark either“Y” for yes or “N” for no to indicate the disclosure of a“significant deficiency.”

Item 8 – Indicate which Federal agency (ies) havecurrent year audit findings related to direct funding orprior audit findings shown in the Summary Schedule ofPrior Audit Findings related to direct funding. Mark (X)the Federal agency (ies) only if the Schedule of Findings andQuestioned Costs discloses audit findings relating to directFederal awards expended, OR, the Summary Schedule of PriorAudit Findings reports the status of any audit findings relatingto direct Federal awards expended.

Item 4 – Is any significant deficiency reported as amaterial weakness? If Item 3 is marked “N,” skipItem 4. If Item 3 is marked “Y,” mark Item 4 either “Y” or “N”to indicate if any significant deficiencies are material weaknes-ses (Circular §__.505 (d)(1)).

Item 5 – Is a material noncompliance disclosed? Markeither “Y” for yes or “N” for no to indicate the disclosure of a“material noncompliance.”

PART III – FEDERAL PROGRAMS

The auditor completes this section of the form.

Item 1 – Does the auditor’s report include a statementthat the auditee’s financial statements includedepartments, agencies, or other organizational unitsexpending $500,000 or more in Federal awards thathave separate A-133 audits which are not included inthis audit (AICPA Audit Guide, Chapter 12)?

Item 6 – Primary Auditor Information

The primary auditor completes this item.

(a-e) Enter the name and contact information of the primaryauditor that conducted the audit in accordance with theCircular. The auditor name may represent a solepractitioner, certified public accounting firm, Stateauditor, etc. Where multiple audit organizations are usedto conduct the audit work, only the lead or coordinatingauditor shall provide its information in Item 6(a-f). Theother auditors may enter their contact information inPart I, Items 8a-f.

(f) Enter a valid email address.

Note: Instructions for uploading secondary auditorcontact information is included in the on-lineinstructions available on the FAC Web site.

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Item 9 – Federal Awards Expended During Fiscal Year –List each program for which Federal awards were expended inthe same order as shown in the Schedule of Expenditures ofFederal Awards. List individual programs in each row.

Break out clusters, with the exception of R&D, and list eachindividual program on a separate line. Report the R&D cluster atthe same level of detail as the Schedule of Expenditures ofFederal Awards.

The information to complete columns (a), (b), (c), (d), (e) and (f)is obtained from the Schedule of Expenditures of FederalAwards. The information to complete columns (g) and (h) isobtained from the Schedule of Findings and Questioned Costsprepared by the auditor. Note that Item 9 includes the requiredinformation for each Federal program presented in the Scheduleof Expenditures of Federal Awards (and notes thereto), regard-less of whether audit findings are reported. If additional linesare needed, photocopy page 3 and attach the additional page(s)to the form, and enter the total expenditures for all pages in the“Total Federal Awards Expended” block on the last page.

CFDA Number – Federal Agency Prefix and Extension

Most common Federal awards are listed in the Catalog ofFederal Domestic Assistance (CFDA). A CFDA number consistsof a two-digit prefix, and a three-digit extension separated bya period. If this information is unavailable, consult the Federalawarding agency or pass-through entity to obtain this number.The CFDA catalog is available on the Internet at:http://www.cfda.gov. If the Federal program does not have aCFDA number, follow the specific instructions below.

Column (a) Federal Agency Prefix – Enter the first twodigits of the CFDA number. The CFDA prefix identifies theawarding Federal Agency listed in Appendix 1. If the FederalAgency does not have a CFDA prefix, use one of the prefixes(noted with an asterisk) assigned for reporting purposes only.

Column (b) CFDA Extension – The period is automaticallyassumed and should not be entered on the form.

9 3 CT-654321-B

Programs with No CFDA Number, Contract Numberor Grant Number

If the program does not have a CFDA number, a contractnumber, or grant number, enter the Federal agency’stwo-digit prefix (as listed in Appendix 1) in the first twospaces. In the extension box, enter “UNKNOWN.”

Example: A U. S. Agency for InternationalDevelopment program with no CFDA number orcontract number would be entered as:

8 4 UNKNOWN

CFDA Number

FederalAgencyPrefix 1 Extension 2

9. FEDERAL AWARDS . . .

Note: CFDA prefixes may not always be the same as theprefixes listed in Appendix I. If an award has a CFDAnumber, use that number. If the program does not havea CFDA number, use the prefix from Appendix I.

Programs with a CFDA NumberIf the Federal program is listed in the CFDA, enter thenumber from the Catalog.

In the first two spaces, enter the first two digits of theCFDA number assigned to the Federal award. In theextension box, enter the last three digits of the CFDAnumber.

Column (c) – Research and Development – Mark either “Y”for yes or “N” for no to indicate if the Federal program is aResearch and Development (R&D) program as defined in§__.105 of the Circular by marking (X) in the appropriate boxto indicate either “Y” or “N”. When a CFDA program consistsof part R&D and part non-R&D, list the R&D expenditure detailon one line and the non-R&D expenditure detail on a secondline.

Researchand

develop-ment

FederalAgencyPrefix 1

Extension 2

9. FEDERAL AWARDS EXPENDED DURING FISCAL YEAR

(a) (b) (c)

CFDA Number

(e)

Name of FederalProgram

WIA Youth Activities

WIA Youth Activities

YN

1

2 x

17 . 259

17 . 259

YN

1

2

x

Example: The U. S. Department of Education program84.033 would be entered as

8 4 033

Programs with No CFDA Number, but AwardHas a Contract or Grant Number

If the Federal program is not listed in the CFDA or hasno CFDA number, enter the Federal Agency’s two-digitprefix as listed in Appendix 1. If the Federal Agency isnot listed in Appendix 1, enter “99” for ”Miscellaneous.”In the extension box, enter the contract or grant numberfrom the Federal Agency (up to fifty digits, letters orcharacters).

Example: A U. S. Department of Health and HumanServices program with no CFDA number but with acontract number of “CT-654321-B” would be entered as:

Notes: (1) Some CFDA prefixes are used by more than oneFederal Agency. Enter the same CFDA prefix used on theFederal award application. If the auditor identified auditfinding(s) for a direct award, identify the specific Federalagency from which the award originated. (2) Three separateagencies use the CFDA numbers beginning with “45.” If oneof those agencies has current year findings related to directfunding or prior audit findings related to direct awards in theSummary Schedule of Prior Audit Findings related to directfunding, mark the box next to an agency using either an“03,” “05,” or “06” prefix from Appendix I. (3) See theHistorical index on the CFDA website (http://www.cfda.gov/)for information regarding the reporting of awards granted bythe Federal Emergency Management Agency, now part ofthe Department of Homeland Security.

Only one copy of the reporting package is required tobe submitted to the Clearinghouse. The auditee mustsubmit only one reporting package (as defined in ’__.320(c))to the FAC. The Clearinghouse will copy and distribute therequired audit reporting packages to Federal agencies per’__.320(d) of the Circular.

Note: Auditors may upload this page via an electronicspreadsheet when using the on-line data entry option.Instructions for this option are included in the on-lineinstructions available on the FAC Web site.

ARRA(d)

YNYN

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Column (h) – Major program – Indicate if the Federalprogram is a major program, as defined in ’__.520 of theCircular by marking (X) in the appropriate box to indicateeither “Y” or “N”.

SF-SAC(I) (4-15-2010) Page 5

DirectAwards

FederalAgencyPrefix 1

Extension 2

9. FEDERAL AWARDS EXPENDED DURING FISCAL YEAR

(a) (b) (g)

CFDA Number

(c)(d)(e)(f)

YN

1

2

x47 . 076

47 . 076

YN

1

2 x

Item 10 – Audit Findings

The rows of Item 10 directly correspond to matching rows inItem 9. The information to complete columns (a) and (b) isobtained from the Schedule of Findings and QuestionedCosts prepared by the auditor. If the Schedule of Findingsand Questioned Costs does not identify audit findings for aspecific row, the auditor should enter “O” for item (a) and“N/A” for item (b). Audit findings affecting more than onemajor program should be listed for all major programsaffected.

Column (a) – Type(s) of Compliance Requirement(s) –Using the list provided on the form in footnote 4 on page 3,enter the letter(s) that correspond to the type(s) ofcompliance requirement(s) applicable to the audit findings(i.e., noncompliance, significant deficiencies (includingmaterial weaknesses), questioned costs, fraud, and otheritems reported under ’__.510(a)) reported for each Federalprogram. Do not list all types of compliance requirementsthat were tested. Normally, audit findings will be covered bythe 14 types of compliance requirements described in Part 3of the “OMB Circular A-133 Compliance Supplement.” Ifthere is an audit finding, but it is not covered by one ofthese, enter “P” for “Other.” If there were no audit findings,enter “O” for “None.” Enter the letters only; do not entercommas or spaces.

Column (b) – Audit Finding Reference Number(s) – Enterthe audit finding reference number(s) for audit findings (i.e.,noncompliance, significant deficiencies (including materialweaknesses), questioned costs, fraud, and other itemsreported under ’__.510(a)) in the Schedule of Findings andQuestioned Costs. If no audit findings were reported, enterN/A for “Not applicable” (footnote 5)

Column (g) – Direct Award – Indicate if the award wasreceived directly from a Federal awarding agency by marking(X) in the appropriate box to indicate either “Y” or “N”. Whenan award consists of both direct and indirect (i.e., received bya subrecipient from a pass-through entity) funds, list the directexpenditure detail on one line and the indirect expendituredetail on a second line. When a single audit reporting entityreceives direct awards and transfers them to another part ofthe same single audit reporting entity, these awards shouldstill be reported as direct (e.g., transfers within the single auditreporting entity do not create a recipient/subrecipientrelationship).

Example:

Example: Each major program (row 1 & 2) must have atype of audit report marked. Do not mark the type of auditreport box for non-major programs (row 3), even thosewith findings.

Note: If two lines are listed for the same CFDA numberbecause part of the award is direct and part indirect, theauditor should repeat the major program information oneach line. If the program is not a major program, leave the“Type of Audit Report” box blank.

Column (d) – American Recovery and Reinvestment Actof 2009 (ARRA) –Mark either “Y” for yes or “N” for no toindicate if the Federal program was funded with Recovery Actawards. Single Audits with fiscal year end dates of September30, 2009 and later must identify ARRA expenditures. If a CFDAprogram involves the expenditures of both Recovery andnon-Recovery Act funding, each must be listed on a separateline.

Column (e) – Name of Federal Program – Enter the nameof the Federal program as shown in the CFDA. If the programis not listed in the CFDA, a description of the awardrecognizable by the awarding Federal agency should beentered. The name of the pass-through entity is not requiredfor indirect awards.

Column (f) – Amount Expended – Enter the amount ofexpenditures included in the Schedule of Expenditures ofFederal Awards for each Federal program. Note that amountsshall include the value of Federal awards expended in theform of non-cash assistance, the amount of Federal insurancein effect during the year. To determine if loans or loanguarantees are considered Federal Awards, refer to the annualOMB Circular A-133 Compliance Supplement or the audit’sFederal oversight (or cognizant) agency. Round to the nearestdollar.

Column (i) – If yes, type of audit report – If Part III, Item9(g) “Major program” is marked “Y” for yes, enter one letter(U, Q, A, or D) corresponding to the type of audit report onthe major program in the adjacent box in Column (h). Entereither ‘U’ for Unqualified opinion, ‘Q’ for Qualified opinion, ‘A’for Adverse opinion, or ‘D’ for Disclaimer of opinion. Forclusters, the type of audit report must apply to the program asa whole. Therefore, all programs in a cluster should share thesame type of audit report and each line should be filled incompletely.

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APPENDIX I-AFederal Audit Clearinghouse Federal Agency Two-Digit Prefix List

(Alphabetic Order)

01* African Development Foundation

98 U. S. Agency for International Development

10 Department of Agriculture

23 Appalachian Regional Commission

* Note: These prefixes are not assigned by the Catalog of Federal Domestic Assistance, and are only used for OMB Circular A-133 reporting purposes only.

88 Architectural & Transportation BarriersCompliance Board

PREVIEW

ONLY

61* International Trade Commission

90 Japan & U.S. Friendship Commission

16 Department of Justice

17 Department of Labor

09* Legal Services Corporation

42 Library of Congress

99* Miscellaneous

43 National Aeronautics & Space Administration

89 National Archives & Records Administration

92 National Council on Disability

44 National Credit Union Administration

05* National Endowment for the Arts

06* National Endowment for the Humanities

68 National Gallery of Art

46 National Labor Relations Board

47 National Science Foundation

77 Nuclear Regulatory Commission

07* Office of National Drug Control Policy

27 Office of Personnel Management

70 Overseas Private Investment Corporation

08* Peace Corps

86 Pension Benefit Guaranty Corporation

57 Railroad Retirement Board

85 Scholarship Foundations

58 Securities and Exchange Commission

59 Small Business Administration

60 Smithsonian Institution

96 Social Security Administration

19 Department of State

62 Tennessee Valley Authority

20 Department of Transportation

21 Department of the Treasury

64 Department of Veterans Affairs

13 Central Intelligence Agency

11 Department of Commerce

29 Commission on Civil Rights

78 Commodity Futures Trading Commission

87 Consumer Product Safety Commission

94 Corporation for National and Community Service

12 Department of Defense

90 Delta Regional Authority

90 Denali Commission

84 Department of Education

90 Election Assistance Commission

81 Department of Energy

66 Environmental Protection Agency

30 Equal Employment Opportunity Commission

32 Federal Communications Commission

33 Federal Maritime Commission

34 Federal Mediation and Conciliation Service

18 Federal Reserve System

36 Federal Trade Commission

39 General Services Administration

40 Government Printing Office

93 Department of Health and Human Services

97 Department of Homeland Security

14 Department of Housing and Urban Development

03* Institute of Museum and Library Services

91 United States Institute of Peace

04* Inter-American Foundation

15 Department of the Interior

7

PREVIEW

ONLY89 National Archives & Records Administration

90 Delta Regional Authority

90 Denali Commission

90 Election Assistance Commission

90 Japan & U.S. Friendship Commission

91 United States Institute of Peace

92 National Council on Disability

93 Department of Health and Human Services

94 Corporation for National and Community Service

96 Social Security Administration

97 Department of Homeland Security

98 U. S. Agency for International Development

99* Miscellaneous

SF-SAC(I) (4-15-2010) Page 7

APPENDIX I-BFederal Audit Clearinghouse Federal Agency Two-Digit Prefix List

(Numeric Order)

* Note: These prefixes are not assigned by the Catalog of Federal Domestic Assistance, and are only used for OMB Circular A-133 reporting purposes only.

88 Architectural & Transportation BarriersCompliance Board

01* African Development Foundation

03* Institute of Museum and Library Services

04* Inter-American Foundation

05* National Endowment for the Arts

06* National Endowment for the Humanities

07* Office of National Drug Control Policy

08* Peace Corps

09* Legal Services Corporation

10 Department of Agriculture

11 Department of Commerce

12 Department of Defense

13 Central Intelligence Agency

14 Department of Housing and Urban Development

15 Department of the Interior

16 Department of Justice

17 Department of Labor

18 Federal Reserve System

19 Department of State

20 Department of Transportation

21 Department of the Treasury

23 Appalachian Regional Commission

27 Office of Personnel Management

29 Commission on Civil Rights

30 Equal Employment Opportunity Commission

32 Federal Communications Commission

33 Federal Maritime Commission

34 Federal Mediation and Conciliation Service

36 Federal Trade Commission

39 General Services Administration

40 Government Printing Office

42 Library of Congress

43 National Aeronautics & Space Administration

44 National Credit Union Administration

46 National Labor Relations Board

47 National Science Foundation

57 Railroad Retirement Board

58 Securities and Exchange Commission

59 Small Business Administration

60 Smithsonian Institution

61* International Trade Commission

62 Tennessee Valley Authority

64 Department of Veterans Affairs

66 Environmental Protection Agency

68 National Gallery of Art

70 Overseas Private Investment Corporation

77 Nuclear Regulatory Commission

78 Commodity Futures Trading Commission

81 Department of Energy

84 Department of Education

85 Scholarship Foundations

86 Pension Benefit Guaranty Corporation

87 Consumer Product Safety Commission

8

NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION

NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION NOT FOR SUBMISSION

Data Collection Form for Reporting on AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS

for Fiscal Year Ending Dates in 2010, 2011, or 2012

FORM SF-SAC(4-15-2010)

U.S. DEPT. OF COMM.– Econ. and Stat. Admin.– U.S. CENSUS BUREAU

GENERAL INFORMATION (To be completed by auditee, except for Items 6, 7, and 8)

Fiscal period ending date for this submission Type of Circular A-133 audit Audit period covered

Program-specific auditAnnual Other – MonthsBiennial

PART I

5.

2. 3.

Yesb. No

AUDITEE INFORMATION 6.

Primary auditor contact telephone

Primary auditor contact FAX

Primary auditor contact E-mail

Name

Title

City

ZIP + 4 Code

// 2

1

2

3

1 2

Month Day Year

Complete this form, as required by OMB Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

OMB No. 0348-0057

b.

d.

e.

f.

Auditee namea.

Auditee address

Auditee contactc.

Auditee contact telephone

Name

Title

(Number and street)

City

State

b.

d.

e.

f.

( ) –

( ) –

( ) –

4. Auditee Identification Numbers

ACTING AS COLLECTING AGENT FOR OFFICE OF MANAGEMENT AND BUDGET

g. g.

Single audit

_ZIP + 4 Code _

_d. Data Universal Numbering System (DUNS) Number

1

__ _Primary Employer Identification Number (EIN)a.

Yese. No1 2

c. f.

Base prints black SF-SAC, page 1, Pantone 100 Yellow, 20% tone

AUDITOR STATEMENT – The data elements and informationincluded in this form are limited to those prescribed by OMBCircular A-133. The information included in Parts II and III of theform, except for Part III, Items 7, 8, and 9a-9g, was transferredfrom the auditor’s report(s) for the period described in Part I, Items1 and 3, and is not a substitute for such reports. The auditorhas not performed any auditing procedures since the date of theauditor’s report(s). A copy of the reporting package required byOMB Circular A-133, which includes the complete auditor’sreport(s), is available in its entirety from the auditee at the addressprovided in Part I of this form. As required by OMB Circular A-133,the information in Parts II and III of this form was entered in thisform by the auditor based on information included in the reportingpackage. The auditor has not performed any additional auditingprocedures in connection with the completion of this form.

Are multiple EINs covered in this report?

If Part I, Item 4b = "Yes," complete Part I, Item 4c on the continuation sheet on Page 4.

AUDITEE CERTIFICATION STATEMENT – This isto certify that, to the best of my knowledge and belief, theauditee has: (1) engaged an auditor to perform an auditin accordance with the provisions of OMB Circular A-133for the period described in Part I, Items 1 and 3; (2) theauditor has completed such audit and presented a signedaudit report which states that the audit was conducted inaccordance with the provisions of the Circular; and, (3)the information included in Parts I, II, and III of thisdata collection form is accurate and complete. I declarethat the foregoing is true and correct.

Auditee contact E-mail

Auditee contact FAX

Primary auditor contact

State

Primary auditor address (Number and street)

Primary auditor name

PRIMARY AUDITOR INFORMATION (To be completed by auditor)

If Part I, Item 4e = "Yes," complete Part I, Item 4f on the continuation sheet on Page 4.

Are multiple DUNS covered in this report?

a.

c.

1.

( ) –

7a. Add Secondary auditor information? (Optional)

Yes No1 2

b. If "Yes," complete Part I, Item 8 on the continuationsheet on page 5.

Auditee certification

Name of certifying official

Title of certifying official Auditor certification Date

Date

DRAFT

9

Is a significant deficiency disclosed for any major program? (§ ___ .510(a)(1))

Page 2 FORM SF-SAC (4-15-2010)

Type of audit report

Unqualified opinion OR

Qualified opinion

1.

Adverse opinion Disclaimer of opinion

Is a significant deficiency disclosed? Yes No – SKIP to Item 53.

Is any significant deficiency reported as a material weakness? Yes4.

Is a material noncompliance disclosed? Yes No5. 1

1

1

1

Primary EIN:

43

2

2

No2

PART II FINANCIAL STATEMENTS (To be completed by auditor)

2

Is a "going concern" explanatory paragraph included in the audit report? Yes2. 1 No2

Indicate which Federal agency(ies) have current year audit findings related to direct funding or prior audit findings shownin the Summary Schedule of Prior Audit Findings related to direct funding. (Mark (X) all that apply or None)

8.

Agriculture

Commerce

DefenseEducationEnergyEnvironmental Protection Agency

Health and Human Services

Housing and UrbanDevelopment

InteriorJusticeLabor

National Science Foundation

Social SecurityAdministration

U.S. Department of StateTransportationTreasury

Veterans Affairs

98

43

Small BusinessAdministration

National Endowment for the Arts

National Aeronautics andSpace Administration

Corporation for Nationaland Community Service

17

64

16

15

14

93

66

81

84

12

94

11

10 05

47

59

96

19

20

21

Institute of Museum andLibrary Services

03

Office of National DrugControl Policy

07

89 National Archives andRecords Administration

General Services Administration39

National Endowment for the Humanities

06

Other – Specify:

Did the auditee qualify as a low-risk auditee? (§___ .530) Yes No3. 1 2

Were Prior Audit Findings related to direct funding shown in the Summary Schedule of Prior Audit Findings? (§___.315(b))

7.Yes No1 2

$2. What is the dollar threshold to distinguish Type A and Type B programs?(OMB Circular A-133 §___ .520(b))

PART III FEDERAL PROGRAMS (To be completed by auditor)

Are any known questioned costs reported? (§ ___ .510(a)(3) or (4)) Yes No6. 1 2

Is any significant deficiency reported for any major program as a material weakness? (§ ___ .510(a)(1))

5.1 Yes 2 No

4. 1 Yes 2 No –SKIP to Item 6

1. Does the auditor’s report include a statement that the auditee’s financialstatements include departments, agencies, or other organizational unitsexpending $500,000 or more in Federal awards that have separate A-133audits which are not included in this audit? (AICPA Audit Guide, Chapter 12) Yes No1 2

None00

U.S. Agency for Inter-national Development

Appalachian RegionalCommission

23

Legal Services Corporation09

_

Homeland Security97

Base prints black SF-SAC, page 2, Pantone 100 Yellow, 20% tone

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23

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