Organization: ___________________________________________
SCP 2014
InterAction Self-Certification-Plus
Member Compliance Reporting Form
ACCOUNTABILTY - TRANSPARENCY - EFFECTIVENESS
InterAction Office of Membership & Standards
1400 16th Street, NW, Suite 210, Washington, DC 20036
202-667-8227
www.interaction.org
Organization: ___________________________________________
COMPLIANCE CERTIFICATION FORM
TABLE OF CONTENTS
INTRODUCTION AND DIRECTIONS .............................................................................................................................................................................................. 1
SECTION I: GOVERNANCE AND ADMINISTRATION STANDARDS ...................................................................................................................................... 2
Component I.A: Board Responsibility.............................................................................................................................................................................................. 2
Component I.B: Board Policies ........................................................................................................................................................................................................ 4
Component I.C: Fiscal Management And Accountability ................................................................................................................................................................. 5
Component I.D: Equal Access Rights ............................................................................................................................................................................................... 7
Component I.E: Organizational Integrity .......................................................................................................................................................................................... 8
Component I.F: Management And Human Resources ...................................................................................................................................................................... 9
SECTION II: PROGRAM STANDARDS ........................................................................................................................................................................................ 10
Component II.A: Program Development ......................................................................................................................................................................................... 10
Component II.B: Fostering Human Rights ..................................................................................................................................................................................... 13
Component II.C: Program Quality Monitoring And Evaluation .................................................................................................................................................... 14
Component II.D: Accountability .................................................................................................................................................................................................... 16
Component II.E: Organizational Security Policy and Plans ........................................................................................................................................................... 16
Component II.F: Fundraising And Commitment To Accurate Disclosure ..................................................................................................................................... 18
SECTION III: ORGANIZATIONAL COMMITMENT STANDARDS ........................................................................................................................................ 18
Component III.A: Administrative And Management ..................................................................................................................................................................... 19
Component III.B: Advocacy And Public Policy.............................................................................................................................................................................. 23
SIGNATURE PAGE AND QUESTIONNAIRE
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
INTRODUCTION AND DIRECTIONS
This 2014 Self-Certification-Plus Compliance Form must be submitted to InterAction by each member organization no later than December 31, 2014. This compliance
process is mandatory for all InterAction members every other year and noncompliance by the deadline will result in suspension from InterAction membership.
Verifying compliance with InterAction PVO standards through the biennial Self-Certification-Plus process is an important mechanism for members to substantiate adherence
to InterAction Standards. It also affords members an opportunity to review their organizational practices, update and revise existing policies and draft new ones as
appropriate, all with the end of improving their organizational effectiveness and accountability.
Additions and revisions: A new section on Protection from Sexual Exploitation and Abuse has been added to match our current PVO Standards. This was approved by the
InterAction Board of Directors in December 2012. We have also modified the compliance questions and the tick boxes in the column “Compliance” to correspond more
accurately with each individual standards component throughout the document.
HOW TO USE THE DOCUMENT:
1. Fill in your organization’s name in the header section of the cover page. The name will automatically then print out on each page. The actual document is in
Microsoft Word “word-wrapping” format with boxes designed to expand as you fill them in. To check a compliance box, double click on it and a window will open
to allow you to change it to a checked box. The completed form, including the signature page provided at the end of this compliance form constitutes a completed
certification document. We also ask you to complete the questionnaire at the end of the document to help us evaluate the process.
2. Column one “Component”: cites the Standards with which you need to verify compliance. Read it carefully as it explains what needs to be verified.
3. Column two “Proposed Evidence”: recommends documentation, policy or procedure you need to gather and review for evidence of compliance.
4. Column three “Compliance”: You need to indicate the level of compliance with the required standard.
5. Column four “Action Plan if not in compliance”: If not in compliance you MUST explain an action plan to become compliant. According to InterAction’s policy
a member is given two years to either come into compliance with non-conformance to a standard or to demonstrate concerted movement toward coming into
compliance in order to avoid possible suspension from membership.
6. Column five” Documentation Gathered”: In this column you are MUST list all the evidence (policy, procedure, practice etc…) you used to verify your compliance.
We cannot declare your compliance complete unless you indicate what documents you reviewed. We do not want you to send us the documentation you used as
evidence of your compliance, but only to cite the documents in that column.
We encourage you to give your feedback on the exercise and suggestions for improving the process. If you have any questions or need additional clarification on how to
complete your report, please contact talexander@interaction.org or bwallace@interaction.org.
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
SECTION I: GOVERNANCE AND ADMINISTRATION STANDARDS
A member Organization shall be governed responsibly by an independent, active, and informed Board of Directors, and, if applicable, its duly constituted Executive
Committee. (Source: § 2.1, 2.2)
Component I.A: Board Responsibility
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
I.A.1 – The Organization’s
board shall act as the
organization’s governing body,
accepting responsibility for
oversight of all aspects of the
organization.
(Source: § 2.1, 2.4)
Copies of pertinent sections of
documents such as bylaws,
charter, policies and procedures
that vest the ultimate authority
in the board to act as the
organization's governing body
with responsibility for
governing all aspects of the
organization.
Copies of pertinent sections of
the policy or bylaws that
specify the frequency of board
meetings, and define the
required attendance. Also
gather and document evidence
that the board meetings were
held as planned and that formal
records of such meetings were
permanently maintained.
Document internal policies and
procedures that are in place to
be used to demonstrate
compliance with all applicable
laws. If legal action has been
initiated against the
organization within the last
three years, document internal
policies and procedures
Yes, have the required
policy and procedures in place.
Not in compliance
I.A.2 – The Organization’s
board policies shall specify the
frequency of board meetings
(at least two meetings per
year), adequate attendance by
directors (at least a majority of
directors on average), and
voting requirements. Records
of the meetings shall be
maintained. (Source: § 2.2)
I.A.3 – Policies and procedures
shall be in place to ensure that
the activities are conducted
within applicable laws.
(Source: § 2.7)
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required
policies, procedures and
processes in place.
Not in compliance
Yes, have the required
policy and procedures in place.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
I.A.4 – The Organization’s
board shall exercise fiscal
oversight of the organization
by:
followed, and any actions
taken, to respond to and resolve
legal action.
The names of the board
members who are currently
serving on the board's financial
oversight committee, including
the name of the organization’s
treasurer, if applicable.
Gather additional evidence, as
appropriate, to verify the
elements of the component.
a) Approving the annual
budget;
b) Appointing an
independent Certified
Public Accountant as
auditor;
c) Receiving and reviewing
the annual, audited
financial statements,
which comply with
Generally Accepted
Accounting Standards and
Requirements according
to the AICPA and the
FASB;
d) Requesting and reviewing
a management letter, if
applicable; and
e) Reviewing the financial
statements and activities
of the organization.
f) Appropriate records shall
be maintained.
(Source: § 2.5, 4.2)
I.A.5 – The Organization shall Copies of all required
annually report to the public by documents.
means of an annual report, or in
separate report formats:
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Yes, have the required
documentation, evidence and
procedures in place.
Not in compliance
Note: Organizations with less
than $100,000 annual incomes
are not required to use an
independent auditor. (Source:
§ 4.2) The board can execute
these functions through the use
of various committees,
including a financial oversight
committee.
Note: Only tick one box! If
non compliant with any of the
sections, “Not in compliance”
box must be ticked and action
plan given in the Action Plan
column.
Yes, have the required
documentation available to the
public.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
a) Audited financial
statements,
b) IRS form 990 if
applicable,
c) List of current board
members,
d) Other information that
may be helpful to the
public in understanding
the organization’s
purposes, goals, activities
and results.
(Source: § 4.5)
Note: If non compliant with
any of the requirements, “Not
in compliance” box must be
ticked and action plan given in
the Action Plan column.
Component I.B: Board Policies
COMPONENT
I.B.1 – Documented board
policies shall:
a) Restrict the number of
employees who are voting
members of the board,
b) Provide limits for
directors being related to
one another, the founder,
or the executive director
or president/chief
executive officer,
c) Establish limited terms of
service for directors and
officers.
(Source: § 2.2)
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
Copies of the appropriate
sections of the organization's
policies and procedures that
address the terms of service,
restrictions on board members’
relationships and services by
employees, and board
members’ compensation and/or
reimbursement for expenses.
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Note: This restriction applies
only to payment for services as
a director and does not apply to
salaried employees who are
also directors. Reimbursement
for out-of-pocket expenses is
not considered compensation.
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
d) Prohibit compensation to
board members for
service as directors.
(Source: § 2.2)
I.B.2 – Organization’s board
policy shall prohibit direct and
indirect conflicts of interest,
requiring that members of the
board and employees:
a) Disclose any affiliation
they have with an actual or
potential supplier of goods
and services, recipient of
grant funds, or organization
with competing or
conflicting objectives;
b) Absent themselves from
discussion and abstain
from voting or otherwise
participating in a decision
on any issue in which there
is a conflict of interest; and
c) Refuse large or otherwise
inappropriate gifts for
personal use.
(Source: § 2.3)
Appropriate records shall be
maintained.
Those sections of the
organization's policies and
procedures that address
potential conflict of interest
situations affecting board
members or employees, and
compile any additional
evidence that the organization
is complying with these
policies and procedures.
Yes, have the required
policies and/or procedures in
place.
Not in compliance
Note: This standard does not
require that the conflict of
interest policy provides an
exhaustive list of conflict
situations, but that such a
policy provides a framework
for determining when a
situation would constitute a
conflict. The management
must report staff conflicts of
interest to the board, report
major credibility risks to the
board, and train new board
members, employees and
volunteers on conflict of
interest requirements.
Component I.C: Fiscal Management and Accountability
The Organization’s finances are conducted in such a way as to assure appropriate use of funds. Appropriate records shall be maintained. (Source: § 4.1)
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Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
COMPONENT
PROPOSED EVIDENCE
I.C.1 – The Organization shall
operate according to a budget
approved by its board.
(Source: § 4.7)
I.C.2 – The Organization’s
combined fundraising and
administration costs shall be
kept to the minimum necessary
to meet the organization’s
needs. (Source: § 4.6)
Copy of the organization's
budget for the current year.
Minutes of board approving the
budget.
The ratio or proportion of the
organization's total combined
fund-raising and administrative
costs to the total expenditures
for each of the past three years.
Yes, have the required
documentation.
Not in compliance
Pertinent materials prepared by
the organization (including
management letters and
conflicts of interest policies in
assessing compliance with
I.A.4 and I.B.2)
Yes, have the required
materials, policies and
processes in place.
Not in compliance
Form 990 filed with the United
States government during the
past three years. If no 990 is
Yes, have the required
documentation.
Not in compliance
Note: The organization should
set an internal target for
fundraising and administrative
expense that is appropriate to
the nature of its structure and
programs. These expenses
should generally not exceed
35% of expenditures.
(Source: § 4.6)
I.C.3 – The Organization shall
exercise adequate internal
controls over disbursements to
avoid unauthorized payments,
prohibiting any unauditable
transactions or loans to board
members and to staff. This
may include descriptions of
procurement policies and
procedures. (Source: § 4.7)
I.C.4 – The Organization shall
file Form 990 annually with the
United States government.
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LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, meet the required ratio
and have the expenditures for
the past three years.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
Note: Religious organizations
should seek legal counsel to
confirm that they are exempt
by law from this component.
(Source: § 4.3)
filed, annual audited financial
statements shall be made
available.
Component I.D: Equal Access Rights
COMPONENT
PROPOSED EVIDENCE
I.D.1 – The Organization shall
ensure that the fundamental
concern of the organization is
the well being of those
affected, and that its programs
assist those who are at risk
without political, religious,
gender or other discrimination.
(Source: § 7.1.6)
Copies of the organization's
instructions, directives, policies
and/or procedures which direct
personnel to adhere to nondiscrimination practices in its
eligibility decisions, and list the
organization's most recent
personnel orientations,
trainings and instructional
material addressing nondiscrimination.
Copy of the written policy and
relevant sections of operational
plans.
I.D.2 – The agency shall have a
written policy that affirms its
commitment to gender equity,
to ethnic and racial diversity, to
the inclusion of people with
disabilities in organizational
structures and in staff and
board composition. The policy
should be fully integrated into
an organization’s plans and
operations, with a mechanism
mandated by the CEO for
overseeing implementation.
(Source: § 2.6.1/2/3 and 7.2.1,
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LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required
policies, procedures and
material in place.
Not in compliance
Yes, have the required
written policy and documents.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
7.3.1, 7.4.1)
Component I.E: Organizational Integrity
The affairs of the Organization are conducted with integrity and truthfulness. (Source: § 3.1)
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
I.E.1 – Each director and
employee shall follow the
organization’s written standard
of conduct that provides that:
 A copy of the
organization's written
standard of conduct
 A copy of the pertinent
section of the
organization's policies and
procedures which address
corrective actions to be
taken in response to
founded wrongdoing by
Board members,
employees, contractors and
volunteers.
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
Copy of the policy that protects
employees who present
evidence of misconduct by
individuals associated with the
Yes, have the required
policy and procedures in place.
Not in compliance
a) The organization opposes
and does not act as a
willing party to
wrongdoing, corruption,
terrorism, bribery, other
financial impropriety, or
illegal acts in any of its
activities;
b) The organization takes
prompt and firm
corrective action
whenever and wherever
wrongdoing of any kind is
found among its board
and employees; and
c) The standard of conduct is
maintained despite possible
prevailing contrary
practices elsewhere.
(Source: § 3.2, 3.4)
I.E.2 – The organization will
have policies to address
complaints and prohibit
retaliation against
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Note: This standard requires
that the organization has
documented policies or
procedures to guide its
investigation of, and corrective
action to, different types of
wrongdoing. These
documented policies or
procedures need not be
exhaustive, but they should
provide a framework for
investigative and corrective
action. Records of the
investigations and corrective
actions shall be maintained.
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
whistleblowers.
(Source: § 3.3)
I.E.3 – The organization will
have policies for document
retention and destruction that
ensure protection of documents
during an official investigation.
(Source: § 3.7)
organization. Verify that
policies and procedures have
been followed.
Gather and review a copy of
policy.
Yes, have the required
policy.
Not in compliance
Component I.F: Management and Human Resources
The organization shall follow management practices that are appropriate to its mission, operations, and governance structure. (Source: § 6.1)
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
I.F.1 – The organization shall
have clear, well-defined,
documented policies and
procedures relating to all
United States employees,
clearly outlining their rights
and benefits.
(Source: § 6.3, 6.3.1)
I.F.2 – The Organization’s
policies shall prohibit
excluding from participation,
denying benefits, or otherwise
subjecting to discrimination
any person on the basis of race,
color, national origin, age,
religion, disability or gender in
any aspect of service delivery
and human resource practices.
(Source: §2.6)
Personnel policies and
procedures or other documents
related to organizational
operations.
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
Policy that affirms the
organization's commitment to
equal access to the
organization's services and
prohibits discrimination by the
organization on the basis of
race, color, national origin,
age, religion, handicap or
gender.
Yes, have the required
policy.
Not in compliance
Track job applications to make
sure all applicants have been
Note: If an organization
treated equally according to
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
claims exemption under section
702 of the Civil Rights Act of
1984, the organization may
consider religion in its
employment practices.
I.F.3 – The Organization shall
have documented policies and
practices that support equal pay
for equal work for women and
men in the United States.
(Source: § 6.4.1.5, 6.4.2.4)
policies and procedures.
Interview HR staff, if
necessary.
Copy of the policies that affirm
the organization’s commitment
to equal pay for equal work.
Yes, have the required
policies.
Not in compliance
Not applicable ( if 100%
volunteer run)
SECTION II: PROGRAM STANDARDS (Advocacy campaigns are considered as programs)
Component II.A: Program Development
Organization’s field programs shall facilitate self-reliance, popular participation and sustainable development. (Source: § 7.1.1)
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
II.A.1 – The Organization’s
programs shall facilitate selfreliance, self-help and popular
participation by empowering
individuals and communities
and strengthening capacities of
local structures. (Source: §
7.1.1, 7.1.8) To this end, the
organization considers such
things as appropriate including
the program’s potential for
individual and community
empowerment;
Draft a concise but
comprehensive description of
the organization’s training
manuals and services or gather
and review a copy of material
containing this information.
The following topics/materials
should be covered and
verified that training was
documented and delivered.
Applicable organizational
policies and standards include:
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
Not applicable (if no field
operations)
 Training manuals or
a) The potential of planned
guidelines for program
activities to strengthen the
design, implementation,
capacity of local
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Note: To achieve this
standard, the organization’s
program planning and
implementation must reflect
efforts to foster mutually
beneficial relationships among
peoples from varied cultural
and economic backgrounds.
Program and senior staff
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
structures;
b) The capacity of
local/regional institutions
to absorb financial and
other inputs
constructively;
c) The potential to
strengthen the capacities
of vulnerable groups,
typically women,
children, minorities, the
disabled, and the very
poor;
d) The potential of local
resources to sustain the
program;
e) Where resources exceed
capacity, the potential to
create new structures such
as locally controlled
foundations or funds;
f) The potential effect upon
local demand and markets
for locally produced
goods and services;
g)The environment impact;
h)The involvement of
appropriate stakeholders
from affected groups; and
i) The program’s potential
to advance the status of
women and their
empowerment.
(Source: § 6.4.1.6; .1.7&7/1/8)

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monitoring and
evaluation
Gender analysis tools for
programming
should be trained in gender
analysis for program planning,
implementation and evaluation.
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
II.A.2 - Where appropriate,
awareness of diversity issues
shall be incorporated into each
stage of the program process,
from the review of project
proposals to implementation
and evaluation, to ensure that
projects foster participation and
benefits for all affected groups.
The agency will collaborate
with partner NGO
organizations in the field to
integrate diversity issues into
their programs.
(Source: § 7.3.2)
II.A.3 - Agency programs and
activities should be held in
accessible locations to the
extent feasible. Organizations
will provide training and
conference materials in
alternative formats as
applicable (Braille, signlanguage interpreters, etc) and
should plan financially to
reasonably accommodate
people with disabilities in their
programs and activities.
(Source: § 7.4.3)
II.A.4 – For those
organizations operating in the
field, the organization shall
give priority to working with or
through local and national
institutions and groups,
encouraging their creation
Program planning, proposal
and program evaluation
guidelines for review of
diversity criteria.
Yes, have the required
documentation, procedures
and/or processes in place.
Not in compliance
Not applicable (if no field
operations)
Review training site locations
and formatting of training
materials developed over the
past year to assess and verify
that accessibility
considerations were followed.
Yes, compliant where
feasible and when financial
resources permit
Not in compliance
Develop a list of the entities
with primary responsibility in
each country where the
organization operates. Gather
organizational policy,
guidelines and/or training
material about working in
Yes, have the required
policy, materials, procedures
and/or processes in place.
Not in compliance
Not applicable (if no field
operations)
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
where they do not already
exist, strengthening them
where they do and developing
clearly and publicly stated
criteria for establishing
partnerships with such groups
and for fostering community
empowerment through
participation in the planning of
programs and projects.
(Source: § 7.1.3)
partnership with local
community groups and/or
instructors.
Component II.B: Fostering Human Rights
COMPONENT
II.B.1 - In its program
activities, the organization
respects and fosters human
rights, both socio-economic
and civil-political.
(Source: § 7.1.4)
PROPOSED EVIDENCE
The organization's instructions,
directives, policies and/or
procedures that address the
privacy and dignity of program
beneficiaries.
LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required
policies, procedures and/or
processes in place.
Not in compliance
Component II.C: Protection from Sexual Exploitation and Abuse
A member has a responsibility to ensure that beneficiaries are treated with dignity and respect and that the core principles stipulated in the PVO Standards s shall be
incorporated into a code of conduct. (Source: §7.8.1)
COMPONENT
II.C.1 A member has a
responsibility to ensure that
beneficiaries are treated with
dignity and respect that certain
minimum standards of behavior
are observed. In order to
prevent sexual exploitation and
PROPOSED EVIDENCE
Organizational code of
conduct, signed by all staff
with copies on file.
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LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required code
of conduct signed and copies
on file.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
abuse, the core principles in
InterAction Standards sections
§ 7.8.2-6 shall be adopted into
a code of conduct.
(Source: § 7.8.1)
II.C.2 Members are obliged to
create and maintain an
environment that prevents
sexual exploitation and abuse
and promotes the
implementation of their code of
conduct. Managers at all levels
have particular responsibilities
to support and develop systems
that maintain this environment.
(Source: § 7.8.7)
Any or all of the following:
SEA workplan, Policies,
procedures and/or processes
documenting staff training
schedules, job descriptions,
subcontractor agreements,
hiring policies, staff and
beneficiary complaint and
response mechanism policies,
and investigations policies.
Yes, have the required
policies, procedures and/or
processes in place.
Not in compliance
Component II.D: Program Quality Monitoring and Evaluation
The organization has established policies and procedures for ongoing monitoring and evaluation of its programs and projects, both qualitatively and quantitatively.
(Source: § 7.1.9)
COMPONENT
II.D.1 – The organization’s
procedures for program
monitoring and evaluation shall
address the effective use of
inputs, including human and
financial resources.
(Source: § 7.1.9)
PROPOSED EVIDENCE
Materials summarizing the
organization's procedures for
monitoring and evaluating the
effective use of inputs.
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LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required
procedures and/or processes in
place.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
II.D.2 – The organization shall
incorporate relevant
monitoring and evaluation
(M&E) practices in its policy,
systems and culture;
Conduct regular and deliberate
evaluative activities to examine
progress towards its goals and
mission; and apply adequate
financial and human resources
for monitoring and evaluation.
II.D.3 – For those
organizations with field
operations, the organization
shall have the capacity to
provide financial and
performance oversight at the
local level, whether through a
field office structure or through
partnerships with local entities.
Note: This component
addresses internal
organizational mechanisms that
assure appropriate, ongoing
oversight of local/regional
program performance. This
component does not address
the external audits performed
annually by an independent
certified auditor.
(Source: § 7.9.14)
Evaluation of completed
programs; meta-evaluation (or
synthesis) of evaluative
activities.
Budget allocation or financial
statements showing allocation
of resources for project and
program monitoring and
evaluation activities; human
resources (staff/consultant)
with primary responsibility for
M&E.
Gather and review selections
from the following:
Design monitoring and
evaluation standards and
evaluation policy for programs
and projects; documents which
show adherence to professional
principles and standards,
including encouraging the
participation of communities
and partners; an agency-wide
M&E system.
Yes, have the required
practices, procedures and/or
processes in place.
Not in compliance
Yes, have the required
policy, documentation,
procedures and/or processes in
place.
Not in compliance
Not applicable (if no field
operations)
Material summarizing the
organization's procedures for
providing oversight of program
finances and performance at
the local level. If any of this
oversight responsibility is
outsourced, gather and review a
copy or summary of the
responsibilities to be carried
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
out by the contractor in this
area.
Component II.E: Accountability
The resources generated are used and accounted for in a manner consistent with the programs and purposes described in appeals.
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
II.E.1 – The organization shall
exercise management and
financial controls to provide
assurance that the donor
contributions are used as
promised or implied in the
fundraising appeal or as
requested by the donor.
(Source: § 4.8)
Policies on accounting
practices and reporting on the
generation and use of restricted
and unrestricted funds, and
document all communications
to the public and donors on the
use of restricted and
unrestricted funds.
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Component II.F: Organizational Security Policy and Plans
InterAction members shall have policies addressing the key security issues (Source: §7.6.1)
COMPONENT
PROPOSED EVIDENCE
II.F.1 – Organizational
Security Policies and Plans:
InterAction members shall
have policies addressing the
key security issues and formal
plans at both the field level and
headquarters levels to address
these issues.
(Source: § 7.6.1)
II.F.2 – Resources to address
security: InterAction members
shall make available
appropriate resources to meet
Materials recording the
organization's requirements for
preparing security plans at both
the field and headquarters
levels.
Yes, have the required
policies, procedures and/or
processes in place.
Not in compliance
Materials recording the
organization's securityrelated resource allocations
and/or budget guidelines
Yes, have the required
materials, procedures and/or
processes in place.
Not in compliance
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LEVEL OF COMPLIANCE
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
these minimum operating
security standards.
(Source: § 7.6.2)
II.F.3 – Human Resource
Management: InterAction
members shall implement
hiring policies and personnel
procedures to prepare staff to
cope with the security issues at
their posts of assignment,
support them during their
service, and address post
assignment issues.
(Source: § 7.6.3)
II.F.4 – Accountability:
InterAction members shall
incorporate accountability for
security into their management
systems at both the field and
headquarters level.
(Source: § 7.6.4)
II.F.5 – Sense of Community:
InterAction members shall
work in a collaborative manner
with other members of the
humanitarian and development
community to advance their
common security interests.
(Source: § 7.6.5)
regarding security related
expenditures.
Note: Expenditures both the
field and headquarters levels.
Materials recording the
organization's procedures to
prepare staff to cope with the
security issues at their posts of
assignment; preparation and
support of staff prior to, during
and after assignments relating
to security risks.
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
Not in compliance
Materials recording the
organization policy regarding
sharing of security information
and other participation in
efforts to enhance mutual
security with other NGO’s.
Yes, have the required
policy, documentation,
procedures and/or processes in
place.
Not in compliance
Note: If no field operations, the
staff at HQ should be advised
and guided about security risks.
If any staff on temporary duty
or visit overseas they should be
prepared to cope with the
security issues.
Materials recording the
Yes, have the required
organization's instructions for
materials, procedures and/or
personnel evaluations related to processes in place.
security.
Not in compliance
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
Component II.G: Fundraising and Commitment to Accurate Disclosure
COMPONENT
PROPOSED EVIDENCE
II.G.1 – The organization shall
be truthful in marketing and
advertising.
Summarize the methods used
to assure the accuracy of
conditions portrayed in the
organization's communications.
If no such guidelines exist,
summarize the methods used to
assure the accuracy of
conditions portrayed in the
organization's communications.
Gather and review samplemarketing guidelines that
address the organization's
accurate portrayal of conditions
in its communications. Survey
donors to verify that the
organization’s intended
message is accurately getting
through.
Note: The organization’s
communications must neither
minimize nor overstate the
human and material needs of
those whom it assists.
(Source: § 5.3)
The organization’s
communications must not
contain any material omissions
or exaggerations of facts,
misleading photographs, nor
any other communication that
would create a false impression
or misunderstanding.
(Source: § 5.2)
The materials must give
accurate balance to the actual
programs for which solicited
funds will be used.
(Source: § 5.2)
LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Yes, have the required
guidelines, methods, and/or
processes in place.
Not in compliance
SECTION III: ORGANIZATIONAL COMMITMENT STANDARDS
Several PVO Standards do not easily lend themselves to clear and objective measurement. More important than defining an absolute measurement is a member's ability to
provide evidence that internal policies have been adopted/implemented, reflecting an organizational commitment to regular, deliberate progress toward meeting these
broader institutional objectives.
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
Component III.A: Administrative and Management
COMPONENT
PROPOSED EVIDENCE
LEVEL OF COMPLIANCE
III.A.1 – The organization
shall be willing to share
program knowledge and
experience with program
participants, other agencies,
donors and other
constituencies.
(Source: § 7.1.10)
III.A.2 – The organization
shall have, or plan to adopt
within its next strategic plan,
written policies that affirm its
commitment to gender
equality, racial and ethnic
diversity and inclusion of
people with disabilities in staff
and board composition, in part
by adopting policies and
procedures to increase:
Review and summarize the
organization's efforts to share
program knowledge and
experience with program
participants, other agencies,
donors and other constituents.
Yes, have the required
procedures and/or processes in
place.
Not in compliance
All policies that affirm the
organization's commitment to
gender equity, racial and
ethnic diversity, and inclusion
of people with disabilities in
organizational structures and
in staff and board composition.
If the organization has not yet
adopted such policies, prepare
written plans to adopt policies,
meeting minutes discussing
the development and adoption
of such policies, or other
relevant documentation.
Assemble copies of personnel
policies that are designed to
address any discrepancies in:
Yes, have the required
policies or plans, procedures
and processes for developing
the policies.
Not in compliance
a) The numbers of women
in senior decisionmaking positions, where
there is underrepresentation, at
headquarters and in the
field;
 The female/male ratio of
b) Ethnic and racial
the senior staff at
diversity, where there is
headquarters and in the
under-representation,
field;
and;
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ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
 The female/male ratio of
the remaining
headquarters staff;
 The percentage of
employees with
disabilities (known to the
organization by the
employee's voluntary
disclosure or some other
legal means).
The organization’s personnel
policies shall identify the
inclusion of family friendly
elements, such as parental
leave, flexible work hours,
telecommuting, etc. Examine
personnel records (approved
leaves, individual work
schedules, etc.) to examine the
extent to which these policies
are being utilized and the
utilization patterns of both
female and male staff.
III.A.4 – The organization
 Samples of advertisements
shall endeavor to recruit and
of recent job openings from
retain staff that combines
newspapers and other media
professional competence with
 Compile job descriptions
a commitment to service.
 Compile samples of recent
internal announcements of
Note: To assist in the
job openings
recruitment and retention of
 Describe opportunities
staff with the skills, experience
made available to staff to
and attitudes that increase the
upgrade skills
probability that service
 Compile a list of the
delivery will meet the
organization’s recruitment
industry's standards for
outreach (e.g., evidence of
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c) The inclusion of people
with disabilities, where
there is underrepresentation.
(Source: § 6.4.1.2,
6.4.2.2, 6.4.3.1)
(Source: § 2.6.1, 2.6.2,
2.6.3) [compare to text
about U.S. procedures in
I.F.3 above]
III.A.3 – The organization
shall institute family friendly
policies and create an
environment that enables both
women and men to balance
work and family life.
(Source § 6.4.1.4)
Yes, have the required
policies in place.
Not in compliance
Yes, have the required
materials, procedures and/or
processes in place.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
efficiency and effectiveness,
the organization should
regularly carry out the
following activities:
a) Define and update
objective entry
qualifications for each job
category,
b) Devise and carry out
effective advertising
campaigns for job
openings,
c) Provide adequate and
equitable staff orientation
and training,
d) Inform staff of current
openings, and
e) Carry out equitable
remuneration and
promotions
III.A.5 – The organization’s
hiring and personnel
evaluation policies and
practices shall demonstrate
commitment to gender and
diversity issues and a
commitment to gender equity
and diversity.
(Source § 6.4.1.3, 6.4.2.3)
specific efforts being made
to reach and attract a more
diverse pool of candidates)
Samples of job descriptions
and candidate interview
questions for criteria/questions
that address commitment to
and experience with
promoting gender equity,
diversity, and inclusion of
people with disabilities.
Review the organization’s
performance assessment form
for criteria/questions on
elements related to advancing
gender equity, diversity, and
inclusion of people with
disabilities.
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Yes, have the required
policies and practices in place.
Not in compliance
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
III.A.6 – The organization’s
performance expectations of
contractors shall be clearly
defined and communicated.
(Source § 6.3.3)
Note: Compliance with this
component can be
demonstrated through
agreements between the
organization and contractors,
including NGOs and other
organizations.
III.A.7 – The organization's
human resource development
program for U.S. staff at all
levels shall promote nondiscriminatory working
relationships and respect for
diversity in work and
management styles by
integrating gender, diversity
and disability sensitization into
its orientation and training
programs.
(Source: § 6.4.1.1, 6.4.2.1,
6.4.3.2, 6.4.1.6)
III.A.8 – The organization
shall make financial
arrangements to protect its
ability to honor its obligations
to employees.
(Source: § 6.3.2)
Standard contracts used
between the organization and
its contractors. If there are any
concerns, survey contractors
for opinions/experience.
Yes, have the required
documentation in place.
Not in compliance
Not applicable (if no
contractors)
Copies and review of the
current curricula used for
orientation and/or training
addressing employment and
service-related diversity issues
including gender, racial, ethnic
and physical disability.
Yes, have the required
documentation and/or
processes in place.
Not in compliance
Review payroll and benefit
plan records to determine that
the organization:
Yes, have the required
records, procedures and/or
processes in place.
Not in compliance
Not applicable (if no paid
employees)



Has accurate records
Pays salaries and benefits
when due
Properly funds employee
retirement plans
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form

III.A.9 – Staff who is engaged
in fundraising and public
relations shall meet the
standards of the Association of
Fundraising Professionals and
Public Relations Society of
America, respectively.
(Source: § 5.7)
III.A.10 – If the organization
engages in fundraising events
or cause-related marketing, the
amount of funds going to the
charity shall be clearly
described prior to, or in
conjunction with the effort.
(Source: § 5.5)
III.A.11 – Organizations that
contract for fundraising
activities shall have written
contracts or agreements
outlining the terms and retain
control of all fund-raising
activities conducted on their
behalf. (Source: § 5.6)
Pays payroll taxes on a
timely basis
 Has corrected any
shortcomings in these
areas, if any, and pointed
out in an audit or
management letter.
Copies of any policies that
address the ethical practices
expected of staff engaged in
fundraising and public
relations.
Yes, have the required
policies
Not in compliance
Samples of advertisements,
invitations, brochures, etc.,
that announce upcoming
fundraising events or provide
cause-related marketing.
Yes, have the required
documentation, procedures
and/or processes in place.
Not in compliance
Not applicable (if not
engaged in fundraising or
cause-related marketing)
Current or anticipated
contracts for fund-raising
activities with the dates they
are in force.
Yes, have the required
contracts and agreements.
Not in compliance
Not applicable (if no
contracted fundraising
activities)
Component III.B: Advocacy and Public Policy
COMPONENT
PROPOSED EVIDENCE
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LEVEL OF COMPLIANCE
ACTION PLAN
IF NOT IN COMPLIANCE
DOCUMENTATION
GATHERED
Questions: Email talexander@interaction.org or bwallace@interaction.org
Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
III.B.1 –The organization shall
have clear policies governing
its decisions and activities
concerning its advocacy, public
policy and/or lobbying
activities, which:
 Describe the criteria or
circumstances in which it
will involve itself; and
 Define the process for
adopting and implementing
such positions.
(Source: § 8.1, 8.2)
III.B.2 –The organization's
advocacy, public policy and
lobbying activities shall
conform to applicable United
States non-profit law.
(Source § 8.3)
The United States non-profit
law provides strict guidelines
for those engaging in activities
aimed at influencing legislation
or other public regulations. The
organization is responsible for
determining if any of its
advocacy or "lobbying"
activities may be prohibited
under these laws and/or
regulations. (Source: § 8.3)
III.B.3 – If the organization
undertakes activities intended
to influence public policy in the
United States or other
Policies that describe the
criteria or circumstances in
which the organization will
involve itself in advocacy or
public policy activities and
which define the process for
adopting and implementing
such positions.
Yes, have the required
policies in place.
Not in compliance
Not applicable (if not
engaged in advocacy)
Written procedures for
assessing the compliance of its
public policy and advocacy
activities with applicable
United States non-profit law.
Prepare a list of public policy
and advocacy activities in
which the organization has
been engaged during the past
24 months, arranged by the
country that is the object of
these activities.
Yes, have the required
policies and procedures in
place.
Not in compliance
Not applicable (if not
engaged in advocacy )
All of the organization's written
procedures for assessing the
compliance of its public policy
and advocacy activities with its
Yes, have the required
policies, documentation,
procedures and/or processes in
place.
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
countries, it shall do so in
accordance with its own
established policies.
(Source: § 8.4)
own policies.
Not in compliance
Not applicable (if not
engaged in public policy and
advocacy activities)
INTERACTION
PVO STANDARDS
COMPLIANCE CERTIFICATION FORM 2012
SIGNATURE PAGE
Name of Organization
Name of CEO or Board Chairman (Please Print)
Signature of CEO or Board Chairman
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Date
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
In order to help us improve and structure the SCP process to offer most benefit to the membership, please answer all of the following
questions.
Did you find the Self-Certification-Plus process useful for you institutionally? If yes, please explain how.
Did the process strengthen your organization’s processes, policies and/or systems? If so, please give examples.
Who lead the effort and who were the other individuals and divisions engaged in Self-Certification-Plus at your organization?
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
Did you discover areas where your organization would benefit from technical assistance?
a. Was it easy and straightforward to select your compliance level in column three?
b. Do you have any recommendations on how the Self-Certification-Plus process might be improved for 2016?
Does your organization verify compliance with any other standards? If so, which ones?
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
Other Comments
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Organization: ___________________________________________
2014 Self –Certification-Plus Compliance Form
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bwallace@interaction.org
Questions: Email talexander@interaction.org or