OMB Control Number 2030-0020Expiration Date 4/30/091/Appendix AEPA Administrative Capability QuestionnaireThe Environmental Protection Agency (EPA) uses the standards set forth in the Code of Federal Regulations, Title 40, Part 30,Subpart C and Office of Management and Budget’s (OMB) CircularA-122 “Cost Principles for Non-Profit Organizations” to assessthe adequacy of administrative management systems. The regulation can be found on EPA=s website athttp://www.epa.gov/ogd/grants/regulations.htmor by searching the US Government Printing Office=s site athttp://www.gpoaccess.gov/cfr/index.html; the OMB Circular can be found on OMB’s website at:http://www.whitehouse.gov/omb/circulars/a122/a122_2004.html. If your organization is being recommended for an EPA grant, andyour organizational policies and procedures do not fully cover the areas outlined in the questionnaire, revised or new policiesmay benecessary to comply with Federal financial management standards.PART I - GENERAL1.Legal Name of the Organization2.Other Organizational Names or Acronyms Used2a Please Identify any affiliated organizations3.Dun and Bradstreet (D&B) Data Universal NumberingSystem (DUNS) Number4. Is your accounting system accrual based or cash based?5. Is your accounting system manual, automated orcombination?6. Has an audit been performed on the organization’sfinancial statement?7. What was the audit opinion?8. If the organization has expended more than $500,000 infederal grant funds within a year, has an A-133 audit beenperformed?9. If yes, were there any major findings?10. Does the organization have an approved indirect cost ratewith the Federal government?11. Has the organization filed any certification/questionnaireregarding its financial managements systems to otherFederal agencies? If yes, please list and provide a copy.U.S. ENVIRONMENTAL PROTECTION AGENCYEPA Form 6600-09Washington, DC 20460OMB Control Number 2030-0020Expiration Date 12/31/052/PART II - ADMINISTRATIVE CAPABILITYInstructions: Check the appropriate box to the right for each item.If your organization has writtenpolicies/procedures that meet therequirement, check the box under theAYes@column. If your organization does nothave written policies/procedures that meet the requirement described under this column, check (/) the box undertheANo@column and explain in the box or in an attachment.Please provide EPA a copy (electronic is preferable) ofthe following items: 1) Most recent audit of financialstatements and management letter, 2) procurement andproperty policies, 3) personnel policies and 4) travel policy. EPA will evaluate your responses against these items.YesNo(explain)STANDARDS FOR FINANCIAL MANAGEMENT SYSTEMS1. Does your accounting and financial management system(s) follow Generally Accepted Accounting Principles? (OMBCircular A-122, Attachment A, A(2)(e))2. Is your financial management system(s) able to relatefinancial data to performance data and develop unit costinformation? (40 CFR 30.21(a))3. Can your financial management system(s) provide accurate, current and complete disclosure of the financial results ofeach federally-sponsored project or program in accordance with the requirements of 40 CFR 30.52? These are theFinancial Status Report and Report of Federal Cash Transactions. (40 CFR 30.21(b)(1))4. Can your financial management system(s) provide records that adequately identify the source and application of fundsfor federally-sponsored activities? Information to beincluded is: authorizations, obligations, unliquidatedobligations, assets, outlays, income and interest. (40 CFR 30.21 (b)(2))5. Does your financial management system(s) provide foreffective control over and accountability for all funds, propertyand other assets, including ensuring that all such assetsare used solely for authorized purposes? (40 CFR 30.21(b)(3))6. Can your financial management system(s) provide fora comparison of outlays with budget amounts for each award,including, where appropriate, information relatedto performance and unit cost? (40 CFR 30.21(b)(4))7. Does your financial management system(s) provide written procedures to minimize the time elapsing between thetransfer of funds to the recipient from the U.S. Treasury and the issuance or redemption of checks, warrants orpayments by other means for the purposes of the program? (40 CFR 30.21(b)(5))8. Does your financial management system(s) provide written procedures for determining the reasonableness, allocabilityand allowability of costs in accordance with OMB CircularA-122, “Cost Principles for Non-Profit Organizations”?(40 CFR 30.21(b)(6))9. Does your financial management system(s) provide accounting records which include cost accounting recordssupported by source documentation? (40 CFR 30.21(b)(7))10.If applicable, does your financial management system(s)provide procedures for conducting an audit in accordancewith OMB Circular A-133? Currently, A-133 audits are required for recipients expending $500,000 or more infederal funds during the fiscal year. (40 CFR 30.26(a))11.Does your financial management system(s) provide or describe existing or planned indirect cost rates? ( OMBCircular A-122 Attachment A, Sections C and D)PROPERTY AND PROCUREMENT STANDARDSEPA Form 6600-09OMB Control Number 2030-0020Expiration Date 12/31/053/Instructions: Check the appropriate box to the right for each item.If your organization has writtenpolicies/procedures that meet therequirement, check the box under theAYes@column. If your organization does nothave written policies/procedures that meet the requirement described under this column, check (/) the box undertheANo@column and explain in the box or in an attachment.Please provide EPA a copy (electronic is preferable) ofthe following items: 1) Most recent audit of financialstatements and management letter, 2) procurement andproperty policies, 3) personnel policies and 4) travel policy. EPA will evaluate your responses against these items.YesNo(explain)1. Does your property management system(s) provide for maintaining: (1) a description of the equipment; (2) anidentification number; (3) source of the property, including the award number; (4) where title vests; (5) acquisitiondate; (6) federal share of property cost; (7) location and condition of the property; (8) acquisition cost; (9) ultimatedisposition information? (40 CFR 30.34(f)(1))2. Does your property management system(s) provide for aphysical inventory and reconciliation of property at leastevery two years? (40 CFR 30.34(f)(3))3. Does your property management system(s) provide controlsto insure safeguards against loss, damage or theft of theproperty? (40 CFR 30.34(f)(4))4. Does your property management system(s) provide for adequate maintenance of the property? (40 CFR 30.34(f)(5))5. Does your organization maintain written procurement procedures which (1) avoid unnecessary purchases; (2) providean analysis of lease and purchase alternatives; and (3)provide a process for soliciting goods and services? (40 CFR30.44(a))6. Does your procurement system provide for the conduct and documentation of cost or price analysis for eachprocurement action? (40 CFR 30.45)PERSONNEL AND TRAVEL1. Does your organization maintain written standards of conduct governing the performance of your employees engagedin the award and administration of contract (i.e., conflict ofinterest) and does it provide for disciplinary actions? (40CFR 30.42)2. Does your organization maintain a personnel system(s) which provides monthly reports on the activities of eachemployee whose compensation is charged to the assistance agreement? (OMB Circular A-122, Attachment B, 8(m))3. Does your organization maintain a standard travelpolicy? (OMB Circular A-122, Attachment B, 51(b))EPA Form 6600-09OMB Control Number 2030-0020Expiration Date 12/31/054/PART III - CERTIFICATION AND SUBMISSIONCERTIFICATION OF APPLICANT=S AUTHORIZED REPRESENTATIVE (REQUIRED):I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I acknowledge that anyknowingly false or misleading statement may be punishableby fine or imprisonment or both under applicable law.Name_________________________________________________________Title__________________________________________________________Signature______________________________________________________Date_____________________________________________________SUBMISSION INSTRUCTIONS:Submit questionnaire with documentation at least 60 days priorto your proposed project start date to [EPA EMAIL ADDRESS]. Ifyou do not have internet access, mail the questionnaire and supporting documentation to the following address:US Environmental Protection Agency (EPA)[MAILING ADDRESS]Attn: [NAME OF CONTACT]If the signed document is submitted by email, it must be submitted in a computer file format, such as Portable Document Format(PDF) developed by Adobe Systems, Inc., that allows authors to exchange documents among different computer systems, whilepreserving the documents' typography and page layout.EPA Form 6600-09The public reporting and recordkeeping burden for this collection of information is estimated to average4hours per response. Send comments on the Agency's need forthis information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collectiontechniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMBcontrol number in any correspondence. Do not send the completed form to this address.