Treasury Office of Gulf Coast Restoration 

RESTORE Act Eligible Entity 

OPERATIONAL SELF-ASSESSMENT (OSA)

OSA Instructions

On July 6, 2012, the President signed the Resources and Ecosystems Sustainability, Tourist Opportunities, and 

Revived Economies of the Gulf Coast States Act of 2012 (RESTORE Act) into law. The Act establishes a Trust 

Fund in the Treasury of the United States, known as the Gulf Coast Restoration Trust Fund. Under the Act, 

amounts in the Trust Fund are available for programs, projects, and activities that restore and protect the 

environment and economy of the Gulf Coast region. For the Direct Component and Centers of Excellence 

Research Grants Program, Treasury is responsible for determining eligibility and monitoring compliance with 

requirements in the RESTORE Act and other federal laws and policies on grants.

Treasury’s RESTORE Act guidance requires that all eligible entities under the Direct Component and the Centers of 

Excellence Research Grants Program complete an Operational Self-Assessment (OSA) prior to receiving funding 

and once a year thereafter. The OSA focuses on operational internal control areas and will be used, in part, to 

assist Treasury in determining an appropriate compliance monitoring protocol. The OSA is not intended to provide 

guidance regarding compliance or audit requirements, but simply as a data gatheringtool.

Please complete the OSA form electronically. Once you have entered the required information, please print the 

last page and have the OSA signed by the individual who has the authority to commit your organization to 

Treasury's grant management requirements. Please scan and include the signature pages with your electronic 

submission.

The completed OSA form should be submitted via email to restoreact@treasury.gov. 

The OSA form contains three parts:

• Organization Contact information

Enter the required descriptive information about the recipient organization and identify the name, title and contact 

information of the individual who is responsible for completing this form. The contact person who completes the 

form may be different from the individual, described above, who has the authority to commit the organization to 

the requirements. Be sure to include the date on which the form was completed.

• Operational Self-Assessment Questions

The OSA questions are organized by the five components of internal control consistent with the Government 

Accountability Office (GAO) Standards for Internal Control in the Federal Government (known as the Green Book): 

control environment, risk assessment, control activities, information and communication, and monitoring. 

Please click on the "Y" to answer Yes or the "N" to answer No for each question in the OSA. Provide any 

additional comments pertinent to your answers. The Comment spaces are set so that the text will wrap when 

you type.

• Certification of the Applicant's Authorized Representative

Identify the individual who has the authority to commit the organization to the Treasury's grant management 

requirements and who can certify the accuracy of the statements made in the form. As noted above, the 

signed certification page is required. 
Treasury Office of Gulf Coast Restoration 

RESTORE Act Eligible Entity 

OPERATIONAL SELF-ASSESSMENT (OSA)

Organization Contact Information

Entity Name

OSA Completed By

Job Title

Contact Details Email Phone 

number

Entity Address

Date OSA Completed

Comments

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a 

valid OMB control number. The valid OMB control number for this information collection is 1505-0250. Comments concerning the time 

required to complete this information collection, including the time to review instructions, search existing data resources, gathering and 

maintaining the data needed, and completing and reviewing the collection of information, should be directed to the Department of the 

Treasury, Office of Gulf Coast Restoration, 1500 Pennsylvania Ave., NW, Washington, DC 20220. 

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Self-Assessment Questions

Environment

Questions Please respond

“Y” or “N” Comments

1. Does management promote open communications

throughout the organization and effectively provide

information to employees and other stakeholders?

Y N

2. Does management provide adequate training and

supervisory oversight to all employees to ensure that the

organization effectively carries out its programs and

activities, including employees working on federal grant

programs?

Y N

3. Do policies, procedures and processes for managing

federal grant funds meet the requirements of OMB 2

CFR Chapter I and Chapter II, Uniform Administrative

Requirements, Cost Principles and Audit Requirements

for Federal Awards?

Y N

4. Are the organization’s internal controls in compliance

with guidance in the ‘‘Standards for Internal Control in

the Federal Government’’ issued by the United States

Government Accountability Office?

Y N

5. Does management regularly create, review and update

policies, procedures and processes to ensure that the

organization effectively carries out its programs and

activities, including updates that may be needed for

federal grant funds?

Y N

6. Does management periodically assess and maintain

proper segregation of duties? Y N

7. Does management have a written code of conduct or

ethics policy that is reviewed and signed off by

employees at least annually?

Y N

8. Does management have a written conflict of interest

policy that is reviewed and signed off by employees at

least annually?

Y N

9. Do management and employees attend anti-fraud

awareness training at least annually and is that training

evidenced by attendance sheets or other mechanisms?

Y N

10. Does management have written policies and procedures

in place for employees to confidentially report suspected

violations of policies and or suspected instances of fraud

or other criminal activity, including specifically those

related to federal grant programs?

Y N

11. Does management perform the following:

a. Address breaches of the code of conduct or ethics

policy

b. Address instances of fraud or other criminal activity

c. Take remedial actions to prevent future violations

d. Notify the appropriate federal agency in cases of

confirmed fraud related to federal funds

Y 

Y 

Y 

Y 

N

N

N

12. Does the organization have a written grants

management manual or standard operating procedures? Y N

N
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Risk Assessment

Questions Please respond

“Y” or “N” Comments

13. Does the organization have a documented internal control

program and risk assessment methodology for managing

and monitoring operational, financial and regulatory

compliance risks that is periodically reviewed and updated

as needed?

Y N

14. Does the organization have a documented risk

assessment and compliance monitoring process in place

specifically for federal grant programs?

Y N

Objectives

Questions Please respond 

“Y” or “N” Comments

15. Allowable / Unallowable Activities & Costs – Does an

effective system of internal controls exists to provide

reasonable assurance that federal awards are expended

only for allowable activities and that the costs of goods

and services charged to federal awards are allowable and

in accordance with the applicable cost principles?

Y N

16. Cash – Does an effective system of internal controls

exists to provide reasonable assurance that the (1)

drawdown of federal cash is only for immediate needs, (2)

reimbursement is requested only after costs have been

incurred, (3) entities comply with applicable Treasury

agreements, and (4)recipients limit payments to

subrecipients to immediate cash needs?

Y N

17. Davis-Bacon Act – Does an effective system of internal

controls exists to provide reasonable assurance that

contractors and subcontractors were properly notified of

the Davis-Bacon Act requirements and the required

certified payrolls were submitted to the non-federal entity?

Y N 

18. Eligibility – Does an effective system of internal controls

exists to provide reasonable assurance that only eligible

individuals and organizations receive assistance under

federal award programs and that subawards are made

only to eligible subrecipients?

Y N 

19. Equipment & Real Property – Does an effective system of

internal controls exists to provide reasonable assurance

that:

a. Proper records are maintained for equipment acquired

with federal awards

b. Equipment is adequately safeguarded and maintained

c. Disposition or encumbrance of any equipment orreal

property is in accordance with federalrequirements

d. A physical inventory and reconciliation of property is

conducted at least every two years

e. The federal awarding agency is appropriately

compensated for its share of any property sold or

converted to non-federal use

Y 

Y 

Y 

Y 

Y 

N 

N 

N 

N 

N 
Objectives (Continued)

Questions

Please respond

“Y” or “N” Comments

20. Real Property Acquisition & Relocation – Does an effective 

system of internal controls exists to provide reasonable 

assurance of compliance with the real property acquisition, 

appraisal, negotiation, and relocation requirements?

Y N

21. Matching, Level of Effort, Earmarking – Does an effective

system of internal controls exists to provide reasonable

assurance that matching, level of effort, or earmarking

requirements are met using only allowable funds or costs

which are properly calculated and valued?

Y N

22. Financial Management – Does a financial management

system provide for effective control over and accountability

for all funds, property and other assets, including ensuring

that all such assets are used solely for authorized

purposed and activities that are allowable in accordance

with the applicable cost principles and are only used during

the authorized period of availability?

Y N

23. Procurement, Suspension & Debarment – Does an

effective system of internal controls (including written

procurement procedures) exists to provide reasonable

assurance that procurement of goods and services are

made in compliance with the provisions of 2 CFR 200 and

that covered transactions are not made with a debarred or

suspended party?

Y N

24. Program Income – Does an effective system of internal

controls exists to provide reasonable assurance that

program income is correctly earned, recorded, and used in

accordance with the program requirements?

Y N

25. Reporting – Does an effective system of internal controls

exists to provide reasonable assurance that reports of

federal awards submitted to the federal awarding agency

include all activity of the reporting period, are supported by

underlying accounting or performance records, and are

fairly presented in accordance with program requirements?

Y N

26. Subrecipient Monitoring – Does an effective system of

internal controls exists to provide reasonableassurance

that:

a. Federal award information and compliance

requirements are communicated tosubrecipients

b. Subrecipient performance is monitored

c. Subrecipient audit findings are resolved, and the

impact of any subrecipient noncompliance on the

pass- through entity is evaluated

d. A risk assessment of the subrecipient is performed

e. Subrecipient eligibility is assessed

Y N

Y N

Y N

Y N

Y N

27. Time-keeping – Does an effective personnel time system

exists which has the capability to create periodic reports of

activities and time of each employee whose compensation

is charged to a project that employee works on, including

each Federal assistance program?

Y N

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Information & Communication

Questions

Please respond

“Y” or “N” Comments

28. Are external and internal Communication channels

established between organization and (1) federal agency,

(2) state agencies, (3) sub-recipients, (4) contractors and

vendors, and (5) other stakeholders?

Y N

29. Is information related specifically to federal fund awards

(including grant agreements, program guidelines, legal

requirements, required reporting and other requirements),

communicated to relevant internal and external

stakeholders?

Y N

30. Does the organization have management, information and

accounting systems in place that are designed to meet all

federal and grant specific program requirements, including

reporting and record retention requirements?

Y N

31. Do information systems policies and procedures exist for

the safeguarding of data, including personally identifiable

information (PII), authorization and addition of system

users, termination of user rights, information back-up and

recovery, and retention and destruction of data?

Y N

32. Is access to data, including PII, protected against

unauthorized access and limited to appropriate individuals

based on job functions?

Y N

Monitoring

Questions

Please respond

“Y” or “N” Comments

33. Are the associated grant fund operations regularly

assessed by an internal auditor, Inspector General and/or

external audit function (Uniform Guidance audit)?

Y N

34. Does the organization formally respond to all internal audit,

Inspector General and external audit findings in writing and

make timely remedial actions/corrections?

Y N

35. Does management periodically review all reports,

deliverables, expenditures, and other requirements related

to federal grant programs to ensure that guidelines and

requirements are being met?

Y N

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Treasury Office of Gulf Coast Restoration 

RESTORE Act Eligible Entity 

OPERATIONAL SELF-ASSESSMENT (OSA)

CERTIFICATION OF APPLICANT'S AUTHORIZED OFFICIAL (REQUIRED)

I certify that the statements made on this form are true, accurate, and complete. I acknowledge that 

any knowingly false or misleading statement may be punishable by fine or imprisonment or both 

under the applicable law.

Name of Authorized Official

Title of Authorized Official

Signature

Date Signed (mm/dd/yyyy)