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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 signed by a duly authorized official (sample
provided in the DCD website).
2. Indirect cost rate proposal providing the following schedules:
____ 2a. Personnel Costs Worksheet, including fringe benefits
breakdown. Agencies may aggregate salary expense by department such as
accounting, human resources, office of director, etc.
____ 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.
____ 2e. Statement of Indirect Costs, including indirect line item of
expenses, allocation base, and indirect cost rate proposed.
3. ____ Financial statements (audited if available) for the applicable
fiscal year.
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 allocation base and the reason for the exclusion.
7. ____ Copy of HHS approved SWCAP, if SWCAP costs are allocated to
federal programs.
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