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OMB Circular A-87 - State & Local
Governments
All organizations except State Workforce Agencies
1. Submit once unless changes are observed:
____ 1a. Organizational chart,
____ 1b. Employee time sheet
sample, providing for distribution of hours to direct/indirect functions.
____ 1c. Cost Policy Statement, describing all accounting policies and
narrating in detail the proposed Cost Allocation Plan. This plan must
describe the procedures used to identify, measure and allocate all costs to
each benefiting activity. This policy must be signed by a duly authorized
official.
2. A Cost Allocation Plan providing the following schedules:
____ 2a. Personnel Costs Worksheet, including fringe benefits
breakdown.
____ 2b. Allocation of Personnel Worksheet, providing
indirect/direct time charges.
____ 2c. Fringe Benefits Worksheet, if
fringes are not directly and indirectly identified.
____ 2d. Statement
of Total Costs, segregated between the indirect and direct costs incurred
by line item of expense (salaries, fringes, rent, etc.), identified by Federal
agency, specific government grant, contract, and other non-Federal
activities.
Note: that the allocation base and the amount of
indirect costs allocated to each funding source should be identified.
3. ____ Financial statements (audited if available) for the applicable
fiscal year. Approved budget for provisional proposal, if needed.
Note: The Statement of Total Costs (2d. above) must
reconcile to Financial Statements. If not, please provide a reconciliation
statement.
4. ____ Signed and dated Certificate of Indirect Costs
(sample form is provided in the DCD website).
5. ____ A listing of grants and contracts by all funding sources, total
dollar amount, period of performance, and the indirect cost limitations (if
any) applicable to each, such as amounts restricted by administrative or
statutory regulations, applicable to the period(s) of the proposal(s). This
listing should also be supported by the approved Federal grant or
contract notification award(s).
6. ____ A schedule listing any funding sources excluded from indirect
cost allocations and the reasons for the exclusions.
7. ____ Copy of HHS approved SWCAP, if SWCAP costs are allocated to
federal programs.
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