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ANNUAL COOPERATOR REPORT

The Annual Cooperator Report (ACR) is to be used to report the financial status of cooperating Federal-State (F-S) 

agencies providing inspecting and auditing services under the Cooperative Agreement titled:

Federal-State Inspection of Fruits, Vegetables and Other Products

State Of Agreement Number

Fiscal Year Beginning Ending

PART 1 - FEDERAL-STATE PROGRAM MANAGEMENT REPORT

Instructions: Answer the following questions for only the Federal-State Program by marking the appropriate box. Unless 

otherwise specified, attach a written explanation for each item marked “No” or “?” (for uncertain) and follow any other 

instructions given.

Attach a listing of current F-S Program fees and the date each fee became effective. Published fee schedules may be 

provided.

The number of all licensed inspectors, graders, aides, samplers and auditors who are supervised under the 

cooperative agreement with the state during this reporting period. Include full and part time auditors, shipping 

point and terminal market licensees.

Number

Questions Yes No ?

1 Have any internal or external audits (not including OMB Circular A-128 Audits) been performed 

either solely on or including the F-S Program during the past five years? (If “Yes,” attach a copy 

(or copies) of the report(s) and answer question #2. If “No,” proceed to question #3.)

2 Have all recommendations relating to the F-S Program made in the prior audit(s) been 

implemented? If “No,” attach a listing of the recommendations and the anticipated dates of 

implementation.

3 Does internal or external audit provide evidence that a reserve fund balance is maintained? (If no 

reserve fund is maintained “No,” proceed to question #5)

4 Is the reserve fund balance maintained in accordance with AMS Directive 408.1 dated 

July 25, 1994?

5 Were F-S Program fees adjusted during the reporting fiscal year? (If “Yes,” attach a brief 

explanation. If “No,” no explanation is required.)

6 Are F-S Program fees adequate to cover program costs? (Complete Part 3. A. – Financial 

Summary, Funding Sources.) 

7 Are procedures in place to ensure that all applicants are accurately billed for the F-S services 

they receive?

8 Is USDA paid its assessments as prescribed in the cooperative agreement?

9 Are procedures in place to keep track of inspectors’ and supervisors’ time to ensure that only the 

time they spend on F-S work is charged to the F-S Program?

10 For expenses such as travel, training, rent, and supplies and equipment, are procedures in place 

to ensure that only those portions applicable to the F-S Program are charged to the FSI 

Program?

11 Are all F-S Program inspections performed by Federally-licensed inspectors?

12 Are all F-S Program employees paid according to job classifications which accurately reflect their 

duties?

13 Are all official USDA inspection certificates and stamps properly secured against misuse?
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14 Are all official USDA inspection certificates and stamps properly accounted for and reconciled on 

a regular basis?

15 Are the principles of equal opportunity and civil rights demonstrated in both F-S Program hiring 

practices and customer service?

CERTIFICATION OF FEDERAL-STATE PROGRAM MANAGER

I certify that the information provided in this report for fiscal year _____ is true, complete, and correct to the best of my 

knowledge and belief. I have attached explanations for any improvements implemented or problems identified since the end 

of fiscal year _____. Type the name and title of the certifying State Agency/Cooperator Official in the space provided below.

Name Date

Title

PART 2 - FEDERAL-STATE PROGRAM FINANCIAL REPORT

Instructions: Answer the following questions for only the Federal-State Program by marking the appropriate box. Unless 

otherwise specified, attach a written explanation for each item marked “No” or “?” (for uncertain) and follow any other 

instructions given.

Questions Yes No ?

1 Are adequate internal controls (including sufficient separation of duties) in place at all levels to 

safeguard FSI Program funds (including all cash receipts)?

2 Are FSI Program funds accounted for separately from those of other programs administered by 

the cooperator?

3 Are all FSI Program-related receipts properly credited to the FSI Program?

4 Are reserve funds invested? (If “Yes,” attach a brief explanation of the investment vehicles and 

amounts and answer question #5. If “No,” proceed to question #6.)

5 Is all interest earned on the invested FSI Program funds credited to the FSI Program?

6 Are adequate internal controls in place to ensure that FSI Program’s billing and collections 

processes functioned properly so that the proper amount due from applicants was billed and 

collected?

7 Are adequate policies and procedures in place to collect delinquent accounts or write off 

uncollectible accounts?

8 Are all FSI Program expenditures properly supported by documentation and approved by 

authorized individuals?

9 Are all user fees collected used only to pay the direct and indirect costs of the FSI Program?

10 Are all FSI Program direct costs allowable in accordance with OMB Circular A-87, “Cost

Principles for State, Local and Indian Tribal Governments,” or A-122, “Cost Principles for 

Nonprofit Organizations”?

11 Are Department or State indirect costs charged to the FSI Program? (If “Yes,” attach a brief 

explanation of the methodology used to allocate these charges, and answer question #12. If 

“No,” proceed to question #13.)

12 Are all indirect costs allowable in accordance with the cooperative agreement and OMB Circular 

A-87 or A-122?

13 Are adequate internal controls in place to ensure the appropriateness of all payroll charges?

14 Are adequate internal controls in place to ensure the appropriateness of all travel charges and 

other reimbursements?
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PART 3 - FINANCIAL SUMMARY

Instructions: Inspection Services are reported separately from Audit services whenever possible. If the State Agency 

cannot reported separately, report the total amounts as Inspection services. Report the amounts for the Fed-State Program 

for both the reporting fiscal year and the prior fiscal year. Attach all explanations and supporting documentation requested 

or which you believe to be necessary. 

Cooperative Market and Shipping Point Inspection Services

Funding Reporting Year Prior Year

User Fees Collected1

Appropriated (State) Funds

Other Funds2

Interest Earned

Total Funding

Expense

Direct Payroll Expenses of the FSI Program3

Direct Expenses of the FSI Program4

Cooperator-Level Indirect Expenses5

State-Level Indirect Expenses6

USDA Assessments

Other Expenses7

Total Expenses

Audit Services

Funding Reporting Year Prior Year

User Fees Collected1

Appropriated (State) Funds

Other Funds2

Interest Earned

Total Funding

Expense

Direct Payroll Expenses of the FSI Program3

Direct Expenses of the FSI Program4

Cooperator-Level Indirect Expenses5

State-Level Indirect Expenses6

USDA Assessments

Other Expenses7

Total Expenses

Grand Total Funding, Inspection Services 

plus Audit Services

Grand Total Expenses, Inspection Services

plus Audit Services

 

1

 Attach a breakout of the fees collected (e.g., hourly, hundredweight, etc.), noting those which were subject to the USDA assessment under the cooperative 

agreement.

2

 Attach an explanation of the source of the funds and for what they were used.

3

 Costs incurred for compensation of personnel devoted specifically to work under this cooperative agreement.

4

 Costs incurred for equipment, materials and services acquired, consumed, or expended specifically for work under this cooperative agreement.

5

 Expenses of the cooperative for supplying goods, services, and facilities for the common benefit of the FSI Program and other programs. Attach an 

explanation of the services that these charges cover.

6

 Expenses of the State for supplying goods, services, and facilities for the common benefit of this and other programs. Attach an explanation of these 

expenses.

7

 Attach an explanation of these expenses.
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Reserve Fund

Reporting Year Prior Year

Beginning Balance

Lowest Balance

Highest Balance

Ending Balance

CERTIFICATION OF FINANCIAL MANAGER

I certify that the information provided in this report for fiscal year _____ is true, complete, and correct to the best of my 

knowledge and belief. I have attached explanations for any improvements implemented or problems identified since the end 

of fiscal year _____. Type the name and title of the certifying State Agency/Cooperator Official in the space provided below.

Name Date

Signature

Title

Non-Discrimination Policy: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, 

offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, 

gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political 

beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and 

complaint filing deadlines vary by program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should 

contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. 

Additionally, program information may be made available in languages other than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at 

http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the 

form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the 

Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is 

an equal opportunity provider, employer, and lender.