Appendix 4

1 November 2022

Next to each category on the form below, enter “Yes,” “No,” or “N/A" to indicate whether criteria have been met. 

Descriptions of expected answers are provided below.

Provide an electronic signed copy of the CFO Representations for Intra-governmental Activity and Balances along 

with the completed Intra-governmental Year-End Material Differences Reports I, II, and III to the federal entity’s IG, 

the Bureau of the Fiscal Service (Fiscal Service) at email address GovernmentwideIGT@fiscal.treasury.gov, and GAO

at email address USCFS@gao.gov by the date specified in the Year-End Closing TFM bulletin.

Note: For all responses to the intra-governmental issues noted below, describe the area and the extent of any 

noncompliance with the requirements in a written response on this form or an attachment, if necessary. Fiscal Service 

may reach out if clarification of a response is needed.

(Refer to the requirements stated in subsection 4750.60, Year-end CFO Procedures for Intra-governmental 

Transactions/Balances.)

Section I. General Intra-governmental Reporting Results Instructions

A. There should be consistency between the federal entity intra-governmental reporting submitted to the Government-wide 

Treasury Account Symbol Adjusted Trial Balance System (GTAS) and the federal entity source documents.

If there is not consistency, provide an explanation.

B. Federal entities should have policies/procedures to record, process, summarize, and report intra-governmental activity/balances by 

trading partner.

If policies/procedures do not exist, provide an explanation.

C. For any activity reported with FR Entity 0000 (Congress: House and Senate), two separate dollar amounts are required: 1) a

dollar amount of the activity that relates to business conducted with the U.S. House of Representatives and 2) a dollar amount of the

activity that relates to business conducted with the U.S. Senate.

D. For any activity reported with FR Entity 9999 that is unknown and unidentified, where the federal entity cannot identify their 

trading partner and has any activity with FR Entity 9999, provide the dollar amount for the activity where the trading partner is 

unknown.

E. If a dollar amount was provided in question “D,” the federal entity must explain why the trading partner cannot be identified 

or is unknown.

F. For any activity reported with trading partner FR Entity 9900 – General Fund of the U.S. Government (General Fund), 

specify whether the federal entity provided the General Fund with the required data by the specified timeframe per Volume I, Part 2, 

Chapter 4700, subsection 4735.30g.

 Note: Fiscal Service will verify this deliverable with the General Fund.

G. For any required data provided to the General Fund by the specified timeframe per Volume I, Part 2, Chapter 4700, 

subsection 4735.30g mentioned in question “F,” specify whether the amounts provided to the General Fund match what was 

reported in the federal entity’s audited financial statements. If they do not match, provide an explanation.

H. Review the Intra-governmental Material Differences Reports provided by Fiscal Service in the Intra-governmental Module of 

GTAS. Federal entities must work with their trading partners to reconcile differences. Specify whether the federal entity contacted their 

trading partners concerning Part I material differences. If they were not contacted, specify which federal entities were not contacted 

and provide an explanation.

I. Specify whether the federal entity’s material differences resulted from an internal error. If there was an internal error, a top 

level journal voucher may need to be completed for the consolidation of the Financial Report of the U.S. Government. Specify

and provide consent if a journal voucher can be completed.

J. Specify whether the independent auditors proposed any adjustments related to intra-governmental balances at year-end.

If so, specify whether any of these adjustments were waived by management and provide an explanation.

K. If the federal entity did not have a CAP that existed for the specific dates, enter N/A. For Corrective Action Plans (CAPs) 

with targeted completion dates between October 1,2022 and September 30, 2023, specify whether the federal entity

implemented these CAPs

If the CAPs were not implemented, specify whether an Extension Request was submitted or whether the difference was 

entered into the Dispute Resolution process.

If either of the answers is “yes,” then enter “yes” in the box.

If both answers are “no,” then enter “no” in the box, provide an explanation and include the CAP number.

Note: Fiscal Service wants to know if the CAPs were implemented, and/or if federal entities are actively working on CAPs, not 

if the status updates were completed.

Instructions: CFO Representations for 

Intra-governmental Activity and Balances Form
Appendix 4

2 November 2022

L. Specify whether the federal entity’s CFO reviewed and monitored the Quarterly Intra-governmental Transactions Metrics and

Scorecards available on OMB MAX.

If they did not, provide an explanation.

M. Specify whether the federal entity’s intra-governmental internal controls are reviewed via an A-123 review. If yes, describe

whether any deficiencies were noted. If no, provide an explanation as to why an A-123 review was not completed.

N. Specify if the federal entity’s internal controls include monitoring, reconciling, and resolving intra-governmental differences

that are not addressed by an intra-governmental process managed by the Bureau of the Fiscal Service within the Department

of Treasury. For example, this would not include work done as a result of a Material Difference Report (MDR), Targeted

Difference Form (TDF), or Root Causes Analysis/Corrective Action Plan (CAP). Responses should include federal entityinitiated processes.

O. Specify if the federal entity’s A-123 review includes internal controls over intra-departmental differences (differences within

an entity itself). If intra-departmental differences exist, explain why they were not resolved by year-end.

P. Specify if the federal entity confirms transactions and balances with trading partners. Describe whether the A-123 review

noted this as an area for improvement.

Q. Specify whether any intra-governmental differences were noted on the Summary of Uncorrected Misstatements above the

federal entity’s materiality threshold. If yes, provide a reason for not making the correcting adjustment and state whether the

entity will make the correcting entry in the subsequent fiscal year.

Section II. Explanation of Year-End Differences

“Yes,” 

“No,” or

“N/A”

Explanation

Specify whether all Intra-governmental Year-End Material Differences Reports (Parts I, II, and III) were explained and certified

in the Intra-governmental Module in GTAS.

If they were not, provide an explanation.

Section III. CFO Confirmation

By signing the form, the CFO acknowledges their responsibility for maintaining effective internal controls when recording intragovernmental transactions, the reconciliation of intra-governmental differences, communication with related trading partners to 

resolve intra-governmental differences, and accurate reporting of intra-governmental activity. We confirm that our agency 

implements and maintains proper and effective internal controls regarding intra-governmental transactions.

Important: The CFO, or equivalent, must sign this form, not a designee. Return an electronic copy to Fiscal Service and GAO 

by specified due date.

Instructions: CFO Representations for 

Intra-governmental Activity and Balances Form
Appendix 4

3 November 2022

Four-Digit FR Entity 

Code Fiscal Year

Federal Entity Name

INSTRUCTIONS: Next to each category enter “Yes,” “No,” or “N/A" to indicate whether criteria have been met. 

Briefly describe the reasons for exceptions. Provide an electronic signed copy of the CFO Representations for 

Intra-governmental Activity and Balances along with the completed Intra-governmental Year-End Material 

Differences Reports I, II, and III to the federal entity’s IG, the Bureau of the Fiscal Service (Fiscal Service) to email 

address GovernmentwideIGT@fiscal.treasury.gov, and GAO to email address at USCFS@gao.gov by the date 

specified in the Year-end closing TFM bulletin. Also refer to the description of requested answers in pages one 

and two of the TFM 2-4700, Appendix 4.

Note: For all responses to the intra-governmental issues below, describe the area and the extent of any noncompliance

with the requirements in a written response on this form or an attachment, if necessary. Fiscal Service may reach out if c

clarification of a response is needed.

(Refer to the requirements stated in subsection 4750.60, Year-end CFO Procedures for Intra-governmental 

Transactions/Balances.)

Section I. General Intra-governmental Reporting Results

“Yes,” 

“No,” or

“N/A”

Explanation

A. Is consistency maintained between the federal entity intra-governmental

reporting submitted to the Government-wide Treasury Account Symbol Adjusted

Trial Balance System (GTAS) and the federal entity source documents?

If “no,” provide an explanation.

A.

B. Does the federal entity have policies/procedures to record, process, summarize,

and report intra-governmental activity/balances by trading partner?

If “no,” provide an explanation.

B.

C. Does the federal entity have activity reported with FR Entity 0000 (Congress:

House and Senate)?

C.

1. If “yes,” indicate the dollar amount of this activity that relates to business

conducted with the U.S. House of Representatives.

1.

2. If “yes,” indicate the dollar amount of this activity that relates to business

conducted with the U.S. Senate.

2.

D. Does the federal entity have activity reported with FR Entity 9999 (Unknown

Trading Partners/Unidentified)?

1. If “yes,” indicate the dollar amount of this activity that relates to truly

unidentifiable trading partners.

D.

1.

E. Does the federal entity have unidentified material differences referenced in

question “D”?

If “yes,” provide an explanation of why the amounts are unidentified.

E.

F. Does the federal entity have activity reported with FR Entity 9900 – General

Fund of the U.S. Government (General Fund)?

1. If “yes,” did the federal entity provide the General Fund with the required data by

the specified timeframe per Volume I, Part 2, Chapter 4700, subsection 4735.30g?

If “no,” provide an explanation.

F.

1.

G. If the federal entity provided the General Fund with required data by the

specified timeframe per Volume I, Part 2, Chapter 4700, subsection 4735.30g

mentioned in question “F,” did the amounts provided to the General Fund

match what was reported in the federal entity’s audited financial statements?

If “no,” provide an explanation.

G.

CFO Representations for 

Intra-governmental Activity and Balances Form

 Mark in Green Areas Only
Appendix 4

4 November 2022

Section I. General Intra-governmental Reporting Results

“Yes,” 

“No,” or

“N/A”

Explanation

H. Review the Intra-governmental Material Differences Reports provided by Fiscal

Service. Were all federal entities contacted or pursued concerning the Part I

material differences? If “no,” list those federal entities that were not contacted or

pursued and provide an explanation.

H.

I. Did the federal entity’s material differences result from an internal error?

If “yes,” provide details (in the explanation box).

1. If “yes,” does the federal entity consent to a top level journal voucher for the

consolidation of the Financial Report of the U.S. Government?

I.

1.

J. Did the independent auditors propose any adjustments related to intragovernmental balances reported at year-end?

1.If “yes,” were any of the auditor's intra-governmental adjustments waived by

management? If “yes,” provide an explanation.

J.

1.

K. If the federal entity did not have a Corrective Action Plan (CAP) that existed

for the specific dates enter N/A. If applicable, did the federal entity implement

all CAPs which had a targeted completion date between October 1, 2022 and

September 30, 2023?

If “no,” was an Extension Request submitted or did the difference enter into the

Dispute Resolution process? If “no,” provide an explanation.

K.

1.

L. Did the federal entity’s CFO review and monitor the Quarterly Intragovernmental Transactions Metrics and Scorecards available on OMB MAX?

If “no,” provide an explanation.

L.

M. Do the federal entity’s intra-governmental procedures undergo an A-123

review? If yes, explain whether any deficiencies were noted. If no, explain why

A-123 review was not completed.

M.

N. Does the federal entity’s internal controls include monitoring, reconciling, and

resolving intra-governmental differences that are not covered by an intragovernmental process managed by the Bureau of the Fiscal Service within the

Department of the Treasury? If so, please describe the controls.

N.

O. Does the federal entity’s A-123 review include the assessment of intradepartmental activity? If intra-departmental differences exist, explain why they

were not resolved by year-end.

O.

P. Does the federal entity confirm transactions and balances with trading

partners? If yes, did an A-123 review find the noted process of communication

effective?

P.

Q. Were any intra-governmental differences listed on the Summary of

Uncorrected Misstatements above the federal entity’s materiality threshold? If

yes, provide a reason for not making the correcting adjustment and explain

whether the intra-governmental difference will be corrected in the subsequent

fiscal year.

Q.

Section II. Explanation of Year-End Differences

“Yes,” 

“No,” or

“N/A”

Explanation

Were all Intra-governmental Year-End Material Differences Reports (Parts I, II,

and III) explained and certified?

If “no,” provide an explanation.
Appendix 4

5 November 2022

Section III. CFO Confirmation

We acknowledge our responsibility for maintaining effective internal controls when recording intra-governmental 

transactions, the reconciliation of intra-governmental differences, communication with related trading partners to 

resolve intra-governmental differences, and accurate reporting of intra-governmental activity. We confirm that 

our agency implements and maintains proper and effective internal controls regarding intra-governmental 

transactions.

CFO Signature (Not a designee) Printed CFO Name Date

CFO Contact Email CFO Contact Phone Number