“SUBRECIPIENT AUDIT AND DATA FORM”
Office of Sponsored Programs, Room 322 EAS
Castle
Point on
Hudson,
Hoboken,(SIT).
NJ 07030
Our records indicate your organization will participate as a subrecipient
with Stevens
Institute
of Technology
Please provide the
following information as soon as possible and return as an email attachment to the individual indicated in the contact email.
NOTE: ALL SECTIONS HIGHLIGHTED IN YELLOW WILL BE COMPLETED BY STEVENS PERSONNEL
A. ORGANIZATIONAL CONTACT DATA
1. FDP Attachment 3A “Pass-through Entity (PTE) Contacts” is provided as a hyperlink.
2. FDP Attachment 3B (page 1) “Subrecipient Contacts” is provided as a hyperlink. This form, signed by an authorized official,
must be received by Stevens before a subaward can be issued.
3. FDP Attachment 3B (page 2) “Subrecipient Highest Compensated Officers” is provided as a hyperlink. This form is required if
an exemption is not available as shown in Section XXXX of this form.
B. ORGANIZATIONAL DESCRIPTION
1. Employer ID# (EIN):
3. Fiscal Year Period (from/to):
2. DUNS+4 #:
4. Name/address of cognizant audit agency:
C (i). Type of Organization –NONPROFIT (check whichever box is applicable AND (F) if
C (ii). Type of Organization – FOR-PROFIT (Check all that apply if the type of
organization is a for-profit business)
appropriate)
a. Institution of Higher Education (audit for compliance with A-
a. Joint Venture
133)
b. Federal Agency (audit for compliance with A-133)
c. State Agency (audit for compliance with A-133)
d. Local Government Agency (audit for compliance with A-
b. Small Business
c. Small Disadvantaged Business
d. Minority-owned Business
133)
e. Non-profit Organization (audit for compliance with A-
e. Woman-owned Business
133)
f. Exempt from A-133 since we expended < $500K of
federal funds for fiscal year in question
f. Service-disabled Veteran-owned Business
g. For-profit Business-indicate state of incorporation:
YES
NO
D. GENERAL INFORMATION (check all that apply)
1. Do you produce annual financial statements that are reviewed or audited by an independent audit firm? (If
“YES,” please provide a copy for most recent fiscal year or a URL where the document can be obtained)
2. Do you consider your cost or pricing data proprietary?
3. Do you have a financial management system that allows identification of the source and application of funds for
activities supported by a specific award?
4. Have there been any significant changes to your financial management system or procedures in the past
two years? (If “YES,” please explain on separate page)
5. Does your financial management system provide for the control and accountability of project funds, property and other
assets?
6. Has your organization managed federal funds previously?
7. Does the PI have less than 2 years experience in managing the technical and administrative details of a research
project?
8. If “YES,” to #7 above, does your organization provide administrative support for account management?
YES
NO
E. FFATA Information
1. The subagreement(s) listed below is/are direct Federal funding or are Federal flow-through?
NOTE TO SUBRECIPIENT: If “YES” is indicated in (E.1) above, you must complete the following and the
congressional district is required of all U.S. subawardees recipients:
1. Location and address of PI’s lab and/or facilities (including congressional district):
OSP form 400
Form created: June 2008
Form revised: October, 2010
Form revised July, 2015
2. Congressional district where research/work is being performed
Please provide information as shown below for all subawards issued by Stevens Institute of Technology to your business or organization.
3. Is work being performed outside of
Congressional District listed above in (E.9)?
3(a). Congressional district where work is being performed for each entry in #11
If “YES” to this question, list separate entry
for each location where work is being
performed outside of Congressional District
shown in E.9.
YES:
NO:
3. Check below if your organization is exempt from reporting executive compensation. If your organization is not exempt from
reporting executive compensation you must provide the names and total compensation of each of the five most highly compensated
executives for your preceding completed fiscal year.
Organization is exempt
3(a)
3(b)
3(c)
3(d)
3(e)
YES
NO
F. GENERAL INFORMATION (check all that apply)
1. We have applied our federally negotiated rates.
2. Employee benefits have been included in the budget.
3. Cost-sharing is required from our organization in the amount of:
4. The research involves the use of human subjects.
5. The research involves the use of animals.
6. Our organization has an organizational Conflict of Interest Policy.
7. Organization has an active financial conflict of interest policy as required by PHS
F. PLEASE CHECK THE APPROPRIATE ITEM AND PROVIDE ANY REQUIRED REPORTS, AS APPLICABLE:
1. Our audit report for the subject fiscal year has been completed. No material weaknesses, no material instances of
noncompliance, and no finding related to any subaward(s) from SIT. Accordingly, we are NOT enclosing a copy of the audit report.
2. Our audit report for the subject fiscal year has been completed. Material weaknesses, material instances of noncompliance, or
finding related to SIT subagreement(s)/subaward(s) to us were noted. Enclosed/or attached is a copy of the audit report and our
response. URL address where most recent audit is available:
3. Our audit report for the subject fiscal year has not yet been completed. We expect the audit to be completed on (
)
(insert date). Within thirty (30) days of completion, we will advise you of the results.
4. Our audit report for the subject fiscal year will not be completed within twelve (12) months after the end of our fiscal year.
Enclosed/or attached is a copy of the approved extension.
5. U.S. For-Profit entity with Federal Awards – [audit for compliance with Federal Acquisition Regulations (FAR), Part 30, if
applicable. If not applicable please offer a text explanation in the space provided in (A.7.) below. Additionally, in order to
demonstrate compliance with FAR, Part 31, we hereby certify, by our signature below, that the prices we provide to SIT are not
greater than those prices charged our most favored customer for like quantities and conditions of sale]
6. U.S. For-Profit entity without Federal Awards or Foreign (non-U.S.) entity – [audit for compliance with general
standards for good business practices; to demonstrate fair and reasonable pricing, we hereby certify, by our signature below, that
the prices we provide to SIT are not greater than those prices charged our most favored customer for like quantities and
conditions of sale]
7. Other / Individual / No audit (explain):
Signature & title of authorized official:
OSP form 400
Date signed:
Form created: June 2008
Form revised: October, 2010
Form revised July, 2015