Reference: Annex G: PRC Submission, Review and Approval form
Partnership Review Committee Submission & Approval Form
Part 1: Submission to the Partnership Review Committee
(to be filled by the requesting officer before submitting to the PRC secretary)
Name of
partner
proposed
CSO
Title of proposed programme
document
Date programme document
submitted by partner
Total value of UNICEF’s
contribution to programme
document
Cash
%
Supplies
%
Total
Country
programme/
Humanitarian Response Plan
output Reference(s)
The following documents are attached to the submission:
Type of document submitted to PRC When required
a.
Partner Declaration
Only if 1st time submission for the CSO during the CP
b.
Copy of CSO registration as
Only if 1st time submission for the CSO or if there is a
per local requirements
change in registration
c.
Legal agreement (PCA)
Only if 1st time submission for the CSO during the CP
d.
Programme Document
Every submission to PRC
(Annex C or Annex B of CSO
Procedure)
e.
Latest Joint Partnership
If there has been any partnership with the CSO for at least
Review1
one year and over $100,000 threshold
f.
Other, indicate:
Type of CSO selection approach used and documentation:
If a direct selection approach was used:
Direct
selection
Proposal submitted by CSO
approach
Proposal requested by UNICEF to CSO
Rationale for using
the direct selection
approach:
If an open selection approach was used:
Open
selection
Generic Call for Expression of Interest (public)
approach
Specific Call for expression of interest (public)
Specific Call for expression of interest (closed)
Reference document Evaluation matrix attached to the submission
1
Information about any prior suspension and/or termination of a programme document, SSFA or PCA with the proposed CSO
partner should be provided by the Programme staff or PRC Secretary.
1
The programme document does not include costs that are already being funded by another programme
document with the proposed CSO.
PO name: ……………………………………… Signature: ……………………………
Title: …..……………………………………
Date: Click here to enter a date
Assessment of risks of working with CSO:
Identify
any
key
risks
associated with the proposed
programme
Planned risk response
The criteria for selection of the CSO and all technical elements of the submission have been approved
by the Head of Section
Name: ………………………………………
Signature: ……………………………
Title: …..……………………………………
Date: Click here to enter a date
If the PRC submission relates to an integrated programme document - covering more than 1 programme
area (e.g. education and WASH), approval on the CSO selection and technical elements has been
obtained from other Heads of Section involved:
Name: ………………………………………
Signature: ……………………………
Title: …..……………………………………
Date: Click here to enter a date
(Add lines as relevant)
Authority has been granted by the Authorizing Officer for commitment of funds.
Amount of financial commitment for the
intended programme document:
Grant reference
Grant
expiry
date
[enter total resources to be transferred]
Amount
Name of Budget Owner: ……………………………..
Title: …..……………………………………
Grant
conditionality,
applicable
if
Signature: …………………………
Date: Click here to enter a date
(Add lines as relevant)
Part 2: Certification of completeness by the PRC secretary
(to be filled in before submitting to the PRC members)
This submission is complete with regards to documentation.
Name: ………………………………………
Signature: ……………………………
Title: …..……………………………………
Date: Click here to enter a date
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Part 3: PRC review and recommendation
(to be completed during the PRC meeting)
Date of PRC meeting: Click here to enter a date.
PRC meeting reference number: CO-PRC/YYYY/###
The PRC has reviewed the key elements of the submission and has the following comments
Considerations
1. Partner selection, assessment & assurance
1.1 The proposed relationship is best
represented and regulated by a partnership (as
opposed to a contractual relationship)
1.2 The partner selection evidences the CSO
comparative advantage in relation to the
planned results
1.3 Required assessments of the CSO have
been carried out or high risk is assumed for the
partnership
1.4 Relevant assurance activities are planned
in line with the HACT Procedure requirements
1.5 Previous relationship with the proposed
CSO, if any, were positive (no significant issues
identified)
2. Programme design
2.1 The proposed programme is relevant to
achieving results outlined in the CP/
Humanitarian Response Plan (HRP)
2.2 Outputs, indicators and targets selected to
measure results are SMART
2.3 Equity, gender and sustainability
considerations have been adequately taken
into account in the programme design
2.4 Activities are clearly defined and adequate
to achieve programme outputs and expected
results
2.5 The budget planned for activities and
articulation of cash and supply assistance is
sound
2.6 The CSO contribution is clearly mentioned
Yes
No
Comments
Not applicable for submission of
Simplified humanitarian programme
documents (Annex B)
2.7 The distribution and overall percentage of
management and operations costs is
acceptable/ within CO defined limits
2.8 If international CSO (or national CSO, if
applicable): headquarters support costs
corresponds to 7% of the UNICEF cash
component
3. Link to other programmes with the same CSO (if applicable)
3.1 There is evidence from other programmes
with the same CSO that the partnership is
effective and results are being achieved as
planned
3
3.2 There is evidence from assurance activities
with the same CSO that no significant issues
have been identified in relation to funds
management
PRC recommendation:
The PRC following its review [recommends / does not recommend] that the Authorized UNICEF Official
should approve the submission for a total value of ……………
With the following adjustments (if any):
1. ..………………………………………………………………………………………………
2. ..………………………………………………………………………………………………
3. ..………………………………………………………………………………………………
Submission requires review by PRC before submission to the Representative: YES: …… NO: ……..
Note: Adjustments listed above not requiring review by PRC will be checked by PRC secretary before
submission to the Representative.
Signature of PRC Members
Member name
Chairperson:
Signature
Date
Objections
Note: Objections, if any, should be recorded by PRC members alongside their signature for review by
the Representative.
4
Review by the responsible section and PRC (if required):
The submission has been adjusted in line with PRC recommendations:
Actioned
Yes No
Revision required by PRC
Comments by the section (if required)
1.
Signature of responsible section:
Name, Title
Signature
Date
Signature of Secretary / or PRC members
PRC member
Secretary/ Chair
Signature
Date
Part 4: Decision by the Representative or Authorized UNICEF Official
Cross the underlined text (agree / disagree) that is not applicable and select Approved/Not Approved by
inserting a check mark next to the selection
I have reviewed the above PRC recommendation and agree / disagree with the PRC recommendation.
The submission is: Approved ……
Not Approved …….
Comments (required if not approved): …………………………………..……………………….……………
……………………………………………………………………………………............................................
……………………………………………………………………………………............................................
Name: ………………………………………………
Signature: ……………………………
Title: …..…………………………………….………
Date: ………………………………….
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