Request for Applications
Public Affairs Content Production, with Emphasis on Elections Reporting
Open to print media outlets
Announced: March 30, 2012
IREX is conducting a grants competition in the frames of its Georgian Media Enhance
Democracy, Informed Citizenry and Accountability (G-MEDIA) Program, which is made
possible by the support of the American People through the United States Agency for
International Development (USAID). IREX has a limited pool of funds to support one year of
public affairs content with an emphasis on elections reporting in print media outlets, which
are published at least weekly. Print media outlets, which have active grants from G-MEDIA
for the similar purposes at the moment when this RFP is issued, are not eligible to apply.
Eligible applicants may apply for the following amounts:
 A Tbilisi based print media outlet is eligible to apply for a grant not exceeding USD
100,000.
 A regional print media outlet is eligible to apply for a grant not exceeding USD
50,000.
The grants aim to allow media outlets to build on their achievements to date and further
improve and expand production of public affairs content, vital for maintaining democratic
discourse in Georgia and serving informational needs of their audiences. Upcoming
parliamentary elections should be one of the key themes of the content produced.
IREX is willing to consider applications for a grant from media outlets, which have
demonstrated commitment to press freedoms and highest professional standards, endured
both market and political pressures, and excelled in providing quality content to their
audiences; have made every effort to make their ownership and finances transparent to
public and provided their employees with higher degree of editorial independence; provided
public with forum for quality discussions of topics of high societal importance; have shown
greater creativity and employed non-traditional approaches, including use of new media, for
expansion and growth; have shown greater care and efficiency in managing funds provided
by donors as well as their own financial resources; have shown concern and care for the
professional development of their employees, supported ethical practices and encouraged
out-of-box thinking.
IREX Small Grants Application
G-MEDIA
The applicants should create mechanisms for ensuring maximum engagement with their
audiences through the use of new media tools and interactive features, for re-packaging for
multiple platforms and the widest possible distribution through alternative channels.
Successful applicants should describe what they plan to achieve with the help of G-MEDIA
funding – for example, improved production quality, increased audience, greater reach, new
interactive features, etc. The proposed activities should feed into the media outlet’s overall
development strategy and enhance its prospects of becoming self-sustaining.
The applicants are required to present a revenue generation plan – to show how production
of proposed content will lead to increased income from advertising and sponsorship to
gradually substitute grant funding. The applicants need to describe how they will measure
increase and demographic change in audience, which advertisers they will target and which
strategies they will employ to capture their attention.
Content produced as a result of the above new grant will be uploaded on the G-MEDIA website in addition to being published/broadcast/posted by respective subgrantees through their
own platforms. This approach will help to increase the audience and impact of the content
produced.
This Call for Applications will be followed by an Open Door Day which will take place in
IREX office on April 11, 2012, at 14:00 am. At Open Door Day interested applicants will be
provided with more detailed guidance on the application process.
The winners of the competition shall receive technical assistance from IREX in the form of
customized consulting and coaching.
Subgrantees will receive consultations on media law from GYLA and on multi-media
approaches from IREX/G-MEDIA’s Senior New Media Manager.
Applications should be received no later than April 18, 2012, 6:00pm to be considered for a
subgrant. Questions regarding this grant application should be submitted to Tatuli Gogadze
no later than April 17, 2012, 6:00 pm See additional contact information below.
Evaluation Criteria for Applications
The G-MEDIA Grants Committee will review the applications against the following criteria:
Organizational Capacity
1. Degree of editorial independence the media outlet exercises;
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2. Degree of financial and ownership transparency;
3. Proven commitment of the applicant to the highest journalistic standards;
4. Potential to grow and improve, assessed on the basis of past performance;
5. Ability of the organization to efficiently handle proposed workload.
Quality of Proposal
1. How important the proposed program is for local community the TV station serves;
2. Effective use of new media tools;
4. Methods used to engage audiences;
4. The degree to which the program may be self-sustaining;
5. Efficient use of resources requested from IREX;
This request for grant application does not commit IREX to pay any costs incurred in the
preparation of a grant application not funded or contract for the services or supplies
described herein. IREX reserves the right to reject any of the applications received. In
issuing this Grants Application document, IREX is not acting as an agent or on behalf of
USAID and USAID will not be party of any resulting Subgrant from this grants program.
Please send signed and sealed application (scanned, in PDF format) electronically to Tatuli
Gogadze at tgogadze@irex.ge Please request confirmation of the receipt after submission.
Alternatively, you can submit hard copy of the application, signed and sealed, accompanied
with electronic copy recorded on CD (scanned, in PDF format) to Tatuli Gogadze at the
address below:
IREX G-MEDIA Program
6, Marjanishvili Street
Tbilisi 0102, Georgia
Office: +(995 32) 291 26 08
Fax: +(995 32) 229 19 05
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ABOUT IREX
IREX (the International Research & Exchanges Board) is the premier US nonprofit
organization specializing in higher education, independent media, Internet development,
and civil society programs in the United States, Europe, Eurasia, the Near East, and Asia.
Since its founding in 1968, IREX has supported over 15,000 students, scholars, policymakers,
business leaders, journalists, and other professionals. IREX serves as a major resource for
universities, governments, and the corporate sector in understanding international political,
social, economic, and business developments.




THE IREX MISSION
Foster democracy in transitioning societies
Strengthen and help internationalize educational, nongovernmental, and media
organizations
Support the highest-quality research in the social sciences and humanities
Identify and train the next generation of leaders by working together with
universities, nongovernmental organizations, foundations, governments, and
corporations
ABOUT G-MEDIA PROGRAM
Funded by USAID, Georgian Media Enhance Democracy, Informed Citizenry and
Accountability Program (G-MEDIA) is to improve the public’s access to a range of sources of
news and information by developing a more politically balanced, editorially independent,
professional and viable media sector that reaches audiences across Georgia through diverse
delivery channels. The program seeks to raise the quality and diversity of media content and
broaden delivery channels; improve professionalism, including through university
journalism education; depoliticize the regulatory environment and strengthen journalists’
capacity to address infringements to their rights and breaches of professional ethics; and
improve the viability of media outlets.
IREX has designed and implemented independent media projects in more than 20 countries
across Europe and Eurasia. IREX also publishes the annual Media Sustainability Index (MSI),
a valuable tool that analyzes the status and progress of independent media.
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Grant Application
The IREX Grant Application consists of five parts:
1.
2.
3.
4.
5.
Narrative Proposal
Budget and Budget Narrative
Grantee Questionnaire
Required Certifications and Forms
Additional Information for Applicant
In addition, the applicants should submit:
1. A plan of how the applicant envisages to make the program at least partially selfsustaining – which advertisers and sponsors will it target, which strategies will it employ to
capture their attention, what is expected revenue, at which rate will revenues grow, etc.
**Applicants must submit all forms for the application to be considered complete**
Part 1 - Narrative Proposal: Applicants must turn in a proposal following this basic format:
I.
Cover Page (including the following information):
 Name of the organization applying (e.g., New York Times)
 Title of grant proposal (e.g., Investigative Journalism Fund)
 Name of responsible official from applicant’s organization
 Address, phone, fax, email
 Date submitted to IREX
II.
Executive Summary (not to exceed one page): This should summarize grant
application, including brief history of applicant, purpose of grant, elements of
project to be funded, amount requested, and expected results.
III.
Organizational Description (one to two pages): Provide a brief history of
organization, current status of ownership (privately held, publicly held, etc.), legal
registration information, staffing structure, decision-making process, editorial
policy, programming schedule or publication content, audience information (ratings
or circulation, target audience, markets served, geographic area of coverage, etc.),
description of organization’s goals for the immediate future.
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IV.
Grant Description: (two to five pages). Describe the purpose of the grant, how
applicant will contribute to the goals of the IREX project, and all staff who will
participate in grant implementation. Provide a detailed timeline for implementation
of the grant activities. If applicant is proposing purchase of equipment and or
services, provide details and consult with IREX on mandatory requirements for
procurement. Specific information that is requested in the grant description would
include:
Beneficiaries:
1. Total number of beneficiaries
2. Age group
3. Occupation
4. Location
5. Impact of the project upon beneficiaries (How will they benefit?)
Project partners (if applicable):
1. Name of partner
2. Role/contribution of the partner
Project Monitoring and Evaluation:
1. Anticipated result of the project
2. Tools and methods for project monitoring and evaluation
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Part 2(a) - Budget: Include a detailed budget and budget narrative in local currency and in US
dollars with an exchange rate at the time budget was completed. IREX issues subgrants in US
dollars and will use an exchange rate from local currency to US dollars at the date when
subgrant is approved (see excel file).
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Part 2(b) – Budget Narrative: A budget narrative serves to explain how the applicant arrived
at budget calculations if not apparent in the budget itself. The narrative serves as justification
for each cost included in a budget and should provide sufficient information for IREX to
determine whether the costs are reasonable. Please note there is no need to repeat the
information that is shown in the budget - the applicant should elaborate and provide
background rationale for the budget costs if it is not apparent in the actual budget. DO NOT
INCLUDE VAT, as IREX is usually exempt under agreements between the US and the host
country.
I. Personnel: Applicant must provide the following information: 1) whether employees listed
are full- or part-time and percentage of time employees will spend on project; 2) position
description if not apparent; and 3) the basis of compensation upon which monthly rates are
based. If any of the information is self-evident on the budget then there is no need to include
it here.
Examples:
A. Editor
$26,000/year 75% on the 5 month project $26,000/12 = $2,166/mo * .75 %
time
= $1,624 *5 months = $8,123 total
Ms. Jones, a full-time employee of KPG, will provide editing services at 75% time. Ms. Jones’
salary is based on the actual current rate for Editor’s at KPG and competitive with market
rates.
Taxes Paid On Employees: Description of taxes required by applicable local laws and basis for
application.
Travel and Per Diem: This budget category provides for inclusion of travel to local, regional,
and international sites, as necessary in the project. The budget narrative (if not already
shown in the detailed budget) should indicate the origin and destination of the traveler(s),
purpose of the trip as it relates to the statement of work, and the source of the costs included
in the budget. Example: airfare from Geneva, Switzerland to Kosovo represents estimated
cost of one round trip economy ticket. The purpose of this trip is to provide a trainer for
course on editing.
Per Diem included in the budget represents funding for staff or participant lodging and
meals. Per Diem can be less, but cannot exceed IREX’s rates for a region without prior IREX
approval. Lodging will be reimbursed based on the actual cost incurred not to exceed IREX’s
local rate for the region. Meals are a fixed cost to be paid minus any meals provided by other
sources. Meal allowance must be reduced for partial travel days. Example: “All Lodging and
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Meals costs are calculated at $45/day for lodging and $15/day for meals which is in
accordance with local hotel rates and meal costs.”
Equipment: Applicant should explain the need for the equipment requested and include the
basis for the cost of the equipment. This means quotations are received from a vendor, the
Internet, or based on a recent purchase (last 6 months) of similar materials, etc. Applicant
must also explain method used or to be used to identify vendor and how the award was made
or will be made. All equipment purchases must be made on a competitive basis unless IREX
approves sole-source procurement in writing. If awarded a grant, applicant must maintain all
records on equipment purchases in accordance with the grant contract with IREX. Example:
Four computers are required to complete the training center and must be Pentium III to
efficiently use the editing software. Quotes on Pentium IIIs were received from three local
vendors. The lowest bidder was selected.
**IREX and its grantees must follow certain rules when procuring equipment and services
relating to the nationality of the supplier, the origin from which it was shipped, and the source
where the equipment was assembled. Refer to Part 4 of the application for further details.**
Supplies: Supplies refer to general office items such as general project supplies,
communications, postage, bank fees, and reproduction costs. Indicate that estimates are based
on past experience or justify quantities in terms of work to be performed. Example: Based on
past experience, we estimate that supplies for the one week of training (paper, pens,
videocassettes) will be $25/person.
Contractual: This line item includes consultants, honoraria, all non-employee labor, and
subcontractors. If the applicant intends to utilize a third party or organization to implement
a portion of the program, the budget narrative should indicate the following:




the method for identifying the party,
the extent to which their competitiveness will be assessed (if no competition will be
sought an explanation must be provided),
a cost breakdown of their services (for example, hourly, daily or other rate), and
indication of whether or not there are existing relationships with the party and
justification for including the specialist or organization in the project.
The estimates provided should be based on quotations, recent historical costs for similar
services or estimates received from vendors who will provide services under an awarded
grant. Example: “KPG will subcontract with ABC Training to provide specialized marketing
training. KPG is the leading trainer in this field and has worked with other media outlets
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such as the NY Times, Moscow Times, and others. They will provide two trainers at the rate
of $200/day for the training.”
Construction: IREX does not normally fund construction costs. If you are applying for any
construction, please consult with IREX before submitting an application.
Other Direct Costs: Applicant should include information on expenses related to the
implementation of project activities such as: seminars, conferences, roundtables, trainings,
receptions (no alcohol will be reimbursed from funds provided through a grant), prizes,
training costs, and so on. The budget narrative should clearly explain these costs in terms of
project activities, estimated number of participants, include relevant calculations, and basis of
costs. Additionally, rental costs for office facilities, training space and utilities should be
included in this section.
For office rent, and other general operating costs, included in the budget the applicant
should explain the percentage of the total cost to be covered through the grant and provide
justification for that portion of rent included as it relates to the goals of the application that
will be supported through this grant. Example: Rental of room for training is $50/day, the
standard rate charged by the training center.
Cost Share: Applicant must also indicate any cost-share and state whether that portion of the
activity will be funded using its own revenues or that of other donors (include donor names).
Example: Two staff of KPG will conduct training at KPG’s expense, calculated at $200/week
for each staff person.
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Part 3 - Grantee Questionnaire: The grantee questionnaire provides basic information about
the organization’s management, financial operations, and capacity to manage a grant. IREX
may at any time ask additional questions, and if awarded a grant, IREX will reserve the right
to conduct an audit or inspection and provide assistance in financial management if
necessary.
Legal Name of Organization (in English, if available):
Legal Name of Organization (in local language, if different):
Mailing Address:
Street Address (if different):
Telephone:
Fax Number:
Email:
US Tax ID Number (if available):
1. What type of organization are you (for-profit, non-profit, university, public/state, etc.)?
2. Is your organization incorporated or registered? Yes:
No:
When and where was your organization incorporated or registered?
3. Please provide a copy of your organization's incorporation or registration certificate.
Enclosed:
Not Enclosed (Explain):
4. What is your organization's legal tax status (fully taxable, partially taxable, tax-exempt)?
5. Is your organization legally affiliated with any other organization? (Local or International)
Yes:
No:
If yes, please provide details:
6. Please list the names of the following individuals:
Chairman of the Board of Directors:
President:
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Executive Director:
Chief Financial Officer/Treasurer:
Head Bookkeeper/Accountant:
7. List the number of employees your organization has:
Full-Time Employees: ______ Part-Time Employees: _______
Consultants: ______
8. Enter the beginning and ending dates of your organization's fiscal year:
From: (Month, Day) _________________ To: (Month, Day) ________________
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9. Financial Information. Please complete the requested information and provide a copy of
your most recent financial statement.
Current Year Information (indicate period):
Revenues: U.S.D. $
Local currency:
Expenses: U.S.D. $
Local currency:
Assets:
U.S.D. $
Local currency:
Liabilities: U.S.D. $
Local currency:
Exchange Rate:
per 1 U.S.D.
Prior Year Information (indicate period):
Revenues: U.S.D. $
Local currency:
Expenses: U.S.D. $
Local currency:
Exchange Rate:
per 1 U.S.D.
Of the current year funding, how much comes from the following (in U.S. dollars):
Membership Dues/Contributions:
$____________
Publications:
$____________
Services:
$
National/Local Governments: $____________
Advertising Revenue:
$____________
Other (specify):
$
Donations -US
$____________
Donations - Non-US
$____________
10. Do you anticipate that your organization will receive other donor funds (US or non-US)
during the period of the IREX grant? Yes:
No:
If yes, please list the funders and funding amounts:
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Part 4 - Required Certifications and Forms: The following certifications are required in
accordance with funder regulations. IREX, as a recipient of USAID funding, is required to
ensure that grantees follow certain regulations. These certifications are part of the process of
ensuring that this is done properly.



Representations and Certifications (Attachment A): All organizations receiving
funds from USAID, even if through a grant, are required to follow certain rules
and regulations. In Attachment A, please find certifications that you will be
required to sign if issued a grant. If you are awarded a grant, these certifications
will be incorporated into the grant document and apply during the grant period. A
full copy of the text will be provided to you upon request. Please sign and return
this attachment indicating you understand that these will apply if you are
awarded a grant.
Procurement Rules (Attachments B-1, B-2, B-3): Under USAID regulations that
apply to IREX and to grantees, certain rules must be followed in procuring
equipment or services. Grantees must purchase goods and services from certain
geographic areas only when using grant funds. In addition, IREX and grantees
must obtain two or more quotes or catalog/published prices for purchases of
equipment or services over $1,000. If over $5,000 there must be 3 written quotes.
IREX will need applicants to fill out and return the applicable Source, Origin and
Nationality Certification for itself and any currently known vendors, grantees or
individuals providing services or goods that would be paid for under the proposed
grant. IREX will assist applicant in the management of this requirement
Financial Capacity Requirements for Grants over $10,000 (Attachment C):
Applicants for grants above $10,000 must complete the form.
Part 5 – Additional Information for Applicant: By submitting a grant application, the
applicant acknowledges that they understand the terms of payment that may be applied to
any award and they understand the requirements described below that will be made part of a
grant agreement.
1. Terms of Payment. IREX at its own discretion will decide the payment terms and
schedule for any grant issued. Selecting the appropriate payment method will
depend on each organization’s fiscal management system in place at the time of
award and the type of work to be funded. IREX reserves the right to make direct
payments to vendors providing services or equipment under a grant.
2. Requirements. Funding for this grants program is provided through IREX from
USAID As such, successful applicants will also subject to these rules and
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regulations. The following will be included in the grant document you receive
from IREX:
 Mandatory Standard Provisions for Non US, Non-Governmental
Organizations.
 Required As Applicable Standard Provisions for Non US, Non-Governmental
Organizations. Only those provisions checked off will apply from this section.
 Property Maintenance and Tracking if a grant authorizes the purchase of
equipment.
 Programmatic and Financial Reporting on a regular basis.
You can find the provisions referenced in Points 1 and 2 above at the following website:
http://www.usaid.gov/pubs/ads/300/303mab.doc.
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ATTACHMENT A
CERTIFICATIONS
**These certifications are required in accordance with
USAID regulations if you are awarded a grant from IREX**
If the applicant receives a grant, they must sign the full text of the applicable certifications
listed below. To review the full text of the requirements please ask the IREX representative for
a copy. If an applicant will not or cannot sign the required certifications a grant cannot be
issued.
1. "Assurance of Compliance with Laws and Regulations Governing Nondiscrimination in
Federally Assisted Programs", as applicable;
2. "Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transaction";
3. "Certification Regarding Debarment, Suspension and Other Responsibility Matters Lower Tier Covered Transactions" from all prospective lower tier participants; as applicable,
4. "Certification Regarding Drug Free Workplace Requirements";
5. Certification and Disclosure forms for "Restrictions on Lobbying."
6. Subcontractor/Subrecipient agrees and certifies to take all necessary actions to comply
with Executive Order No. 13224 on Terrorist Financing; blocking and prohibiting
transactions with persons who commit, threaten to commit, or support terrorism. Executive
Order
13224
text
provided
in
Appendix
D
and
also
available
at:
http://www.whitehouse.gov/news/releases/2001/09/20010924-1.html
The attachment does not include 'Names of Those Designated' after 23 September 2001;
therefore, you are required to obtain the updated list at the time of procurement of goods or
services.
The
updated
list
is
available
at:
http://treasury.gov/offices/enforcement/ofac/sanctions/terrorism.html
7. Applicant will certify that no funds provided by IREX will be used toward the purchase of
the following Ineligible Items: 1) Military Equipment; 2) Surveillance Equipment; 3)
Commodities and Services for support of police or other law enforcement activities; 4)
Abortion Equipment and services; 5) Luxury goods and gambling equipment; or 6) Weather
modification equipment.
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8. Applicant will certify that it will not procure the following without IREX approval: 1)
Agricultural commodities; 2) Motor vehicles; 3) Pharmaceuticals; 4) Pesticides; 5) Used
Equipment; 6) U.S. Government-owned excess property; and 7) Fertilizer.
9. Applicant will certify that items to be paid for by USAID through a subgrant issued under
this application will not also be reimbursed by another donor or another U.S. government
funded agreement to subgrantee.
10. Applicant will follow competitive procurement guidelines for all purchases over $1,000
using grant funds. This will require three written bids from vendors, justification of
selection, and written records of all purchases using subgrant funds.
Applicant provides its signature below to indicate that it understands and acknowledges the
requirements of this section and does not foresee a problem with signing the certifications at
time of signing the subgrant document.
_____________________________________
___________________________
Authorized Official of Applicant
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ATTACHMENT B-1
SOURCE, ORIGIN AND NATIONALITY CERTIFICATION
TO BE USED FOR INDIVIDUAL PURCHASES OF GOODS AND SERVICES OVER $5,000
Subgrant Number: __________________________
Vendor Name: ______________________________
A.
NATIONALITY - COMPLETE FOR SUPPLY OF GOODS AND/OR SERVICES
This is to certify that the NATIONALITY of _______________________ is:
ADDITIONALLY, CHECK ONE OF THE FOLLOWING:
□
□
An individual who is a citizen or legal resident of _________________; or
□
A controlled foreign corporation of which more than 50% is owned by United States
citizen or organization; or
□
A joint venture or unincorporated association consisting entirely of individuals, or
organizations of which more than 50% is owned by United States individual or
organization. The legal Status of these principals are as follows:
B.
A corporation or partnership organized under the laws of the country of
________________; or
SOURCE/ORIGIN - COMPLETE FOR SUPPLY OF GOODS ONLY
This is to certify that the SOURCE (the country from which a commodity is shipped) of the
goods to be supplied under this order is: _________________________ .
This further certifies that the ORIGIN (the country where goods are produced through
manufacturing, processing or substantial and major assembling of components) of the goods
to be supplied under this order is: ____________________________ .
C.
FOREIGN POLICY RESTRICTED COUNTRIES
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Vendor further certifies by signing this document that no commodity, or component of
commodity, provided under this activity are procured from Cuba, Libya, Laos, Iraq, Iran,
North Korea, or Syria.
CERTIFIED BY SUPPLIER:
Signature: _______________________
Printed Name: ____________________
Date: ____________________________
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ATTACHMENT B-2
SOURCE, ORIGIN AND NATIONALITY CERTIFICATION
TO BE USED WHEN PROCURING GOODS AND SERVICES UNDER $5,000
Subgrant Number: __________________________
Vendor/Individual Name: ______________________________
A. Individuals and organizations providing goods and services under $5,000, by signing this
document, certify that they are located, organized, or owned, by citizens or organizations in
Geographic Code 935*.
Individuals or organizations providing goods and services, hereby, certify that they are
located or organized and owned in the following country: ________________________
B. Vendor certifies that by signing this document no commodity, or component of
commodity, provided under this activity is procured from Cuba, Libya, Laos, Iraq, Iran,
North Korea, or Syria.
CERTIFIED BY SUPPLIER:
Signature: _______________________
Printed Name: ____________________
Date: ____________________________
*Services from individuals or organizations located and owned or organized (full or partially)
in the following foreign policy restricted countries cannot be paid with USAID funds; Cuba,
Libya, Laos, Iraq, Iran, North Korea, or Syria. This does not include individuals lawfully
admitted for permanent residence in the United States.
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ATTACHMENT C
FISCAL QUESTIONNAIRE
TO BE USED WHEN APPLICANT IS APPLYING FOR MORE THAN $10,000
If the applicant is applying for more than $10,000, applicant must provide their most recent
income statements and balance sheets for the current and most recently completed fiscal
year and at least one of the following:



Completed attached Questionnaire (Sections A. – E.),
Copy of most recent “A-133” audit, or
Written documentation from at least three consecutive successful completed annual
audits by external auditors in accordance with generally acceptable accounting
standards
Note: If any of the financial information provided by the applicant is not minimally
acceptable to the IREX Grants Compliance Office (GCO) in Washington, DC, the applicant
may be required to submit to an external audit whose scope and auditor will be determined
by IREX or to sampling audits of invoices, receipts, procurement files and financial reports
during the term of the grant.
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SECTION A: INTERNAL CONTROLS
Internal controls are procedures which ensure that: 1) financial transactions are approved by
an authorized individual and are consistent with laws, regulations and the organization's
policies, 2) assets are maintained safely and controlled, and 3) accounting records are
complete, accurate and are maintained on a consistent basis. Please complete the following
questions concerning your internal controls:
1. List the name and position title for the following person(s):
Responsible for cash:
Name:
Title:
Responsible for bank accounts:
Name:
Title:
Responsible for equipment:
Name:
Title:
Responsible for reviewing expenditures to make sure they are allowable:
Name:
Title:
Responsible for keeping all receipts and other documentation to support expenses charged to
this grant:
Name:
Title:
Responsible for signing checks:
Name:
Title:
Responsible for maintaining the accounting records:
Name:
Title:
Responsible for reconciling bank statements to the accounting records:
Name:
Title:
Responsible for preparing financial reports for this grant:
Name:
Title:
2. Describe the types of reconciliations (e.g., bank) performed, and how frequently they are
performed.
Type of reconciliation
Frequency
_________________________________
________________________
_________________________________
________________________
_________________________________
________________________
_________________________________
________________________
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3. Are timesheets maintained for each employee to document payroll expenses?
Yes:
No:
(Explain why not)
4. Is each employee's salary documented in an employment letter or contract?
Yes:
No:
(Explain why not)
5. Do you maintain inventory records of capital equipment (e.g., computers, copier, fax, etc)?
Yes:
No:
(if no, explain why not)
6. How often do you compare inventory records to the actual inventory?
7. If the inventory was purchased with IREX or USG project funds in the past, is the
inventory identified as IREX's or USG’s? Yes:
No:
(if no, explain why
not)
SECTION B: ACCOUNTING SYSTEM
The purpose of an accounting system is to: 1) accurately record all financial transactions, and
2) ensure that financial transactions are supported by invoices, timesheets or other
documentation. The type of accounting system often depends upon the size of an
organization. Some organizations may have computerized accounting systems while others
use a manual system to record each transaction in a ledger. In all cases, IREX grant funds
must be properly authorized, used for the intended purpose and recorded in an organized
and consistent manner.
1. Briefly describe your organization's accounting system. At a minimum, describe: a) any
manual ledgers used to record transactions (general ledger, cash disbursements ledger,
accounts payable ledger, etc); b) any computerized accounting system used (please indicate the
type); c) how recorded transactions are summarized for financial reporting purposes, and d)
the frequency of financial reports.
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2. Do you have written accounting policies and procedures?
Yes:
3. Are your financial reports prepared on a:
Accrual basis:
Cash basis:
No:
4. Can the accounting records identify and distinguish the receipts and payments of a IREX
grant from the receipts and payments of other activities? Yes:
No:
5. Can the accounting records summarize payments by budget category? Yes:
No:
6. How will you ensure that line item and overall budget limits for the IREX grant will not be
exceeded?
7. Do you maintain invoices, vouchers and timesheets for all payments? Yes:
No:
8. Are there any circumstances in which invoices, vouchers and timesheets cannot or will not
(if yes, explain)
No:
be obtained? Yes:
9. Briefly describe your organization's system for filing and maintaining supporting
documentation.
10. Will you be able to maintain accounting records including invoices, vouchers and
timesheets for at least three years after the final financial report is submitted? Yes:
No:
(Please explain)
11. Do you have a negotiated overhead rate? (This is a flat rate for administrative expenses,
which is charged for each project.) Yes:
(Please enclose approved rates)
No:
SECTION C: FUND CONTROL
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Access to the bank account where grant funds are deposited should be limited to authorized
individuals. Bank balances should be reconciled periodically to the accounting records. If
cash cannot be maintained in a bank, it is very important to have strict controls over its
maintenance and disbursement.
1. Can a separate bank account be established just for IREX grant funds? Yes:
No:
2. Are all bank accounts and check signers authorized by the Board of Directors, Trustees,
Executive Committee or Financial Management Committee of the Board?
Yes:
No:
3. Will any cash from IREX funds be maintained outside the bank (in petty cash funds, etc.)?
Yes:
No:
If yes, please explain the amount of funds to be maintained, the purpose and person
responsible for safeguarding these funds.
4. If you don't have a bank account, what do you do to make sure that cash is maintained
safely?
5. Please answer the following:
a. Are bank deposits insured by the government?
Yes:
No:
b. Do you intend to convert U.S. currency to local currency? Yes:
No:
c. Are there any taxes or other charges when converting U.S. dollars to local currency?
(Please explain).
Yes:
No:
d. Are there any government restrictions on the number of bank accounts a single
organization may maintain?
Yes:
No:
e. Are there any government or bank restrictions on the use of checks for making
payments or withdrawals? (Please explain.) Yes:
No:
f. Will it be possible for you to establish a bank account in U.S. dollars?
No:
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g. Are there any government or bank restrictions, taxes or other charges that will be
placed on U.S. dollar bank accounts? (Please explain).
Yes:
No:
SECTION D: AUDIT
IREX's grant provisions may require an audit to be performed of your accounting records.
Please provide most recent audit with the application.
1. Does your organization have regular audits?
Yes:
No:
a. If yes, who performs the audit and how frequently is it performed?
b. If you receive an IREX grant, will IREX grant funds be included in such an audit?
Yes:
No:
N/A (not applicable):
c. If yes, would it appear as a separate project? Yes:
No:
N/A:
d. Would the report be prepared in, or translated into English? Yes: No:
N/A:
2. If you do not have a current audit of your financial statements, please provide this office
with a copy of the following financial statements, if available:
a. A "Balance Sheet" for the most current and previous year; and
b. An "Income Statement" for the most current and previous year.
3. Are there any reasons (local conditions, laws, or institutional circumstances) that would
prevent an independent accountant from performing an audit of your organization? If yes,
please provide details:
SECTION E: FORM CERTIFICATION
FORM COMPLETED BY:
PRINTED NAME
SIGNATURE
______________________________________________
TITLE
DATE
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APPROVED BY:
PRINTED NAME
SIGNATURE
______________________________________________
TITLE
DATE
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