Information Needed for an Evaluation of an Indirect Cost Rate Proposal

OMB No. 3136-0134
Expires June 30, 2009

Identify your response by number

This form requests copies of information from your files, or answers to questions requiring a narrative statement. In some cases, a yes or no may be an appropriate answer. Information needed:

1. A copy of your most recent audited financial statements on which the proposal is based. The proposal should be based on a period that includes grants which provide for indirect costs. You may want to contact this office to properly identify the correct period.

2. A list of grants active during the period and current applications for grants submitted to the National Endowment for the Humanities, as well as other federal agencies. The grants and applications should be identified by purpose, amount, period covered and numbers assigned by the grantor agency. Indicate if grant provided for indirect cost.

3. A schedule of indirect salaries. The schedule should include job title, amount and brief description of duties. Some salaries may need to be allocated between direct and indirect activities. The amount allocated to each cost center should be identified and a description of the direct and indirect duties, shown separately, should be provided.

4. A schedule of fringe benefits and payroll taxes by type and amount. Explain the method by which fringe benefits are charged/allocated to cost centers. Indicate which employees are entitled to benefits.

5. A reconciliation of the proposal to your audited financial statements in total and by cost center.

6. An analysis of the total insurance charged in the proposal by type of policy and amount. Provide a reconciliation of insurance charged to each cost center.

7. The date and number of your last egotiation, and the name of the federal agency which negotiated the rate.

8. Is all of the organization's financial activity reported in the financial statement and in the proposal? If not, please explain.

9. Is the organization affiliated with another organization? If so, is it a non-profit or a commercial enterprise?

10. Are all items listed as revenue/income gross amounts only? If not, please identify gross revenue and cost.

11. Are payments made to retired employees? If so, please identify the cost center where the costs are charged.

12. Do programs or projects take place on-site or off-site?

13. A schedule of all sub-contracts over $25,000.

14. How many members does the organization have? Provide a schedule of the classes of dues. What benefits are provided members? Who maintains the membership records?

15. Does the organization use the services of volunteers? Is the fair market value recorded in the financial statement? If not, provide a schedule of volunteer hours by job function for each cost center. Does the organization maintain records for volunteers if is this an estimate?

16. For the next fiscal year, does the organization anticipate a significant change in the level of program activity? Would this change impact on the rate?

17. Provide a budget for the next fiscal year.

18. Are fund raising and investment management/custodial fees identified in the proposal? If not, provide the following: 1) total fund raising costs; and 2) total investment management costs.

19. Depreciation. A schedule of amounts by type of asset.

20. Please submit copies of personnel activity reports, for a one month period, for those employees whose compensation is charged in whole or in part to grant activity. In addition, such reports for those employees whose compensation is charged/allocated between direct and indirect cost centers. During our review we will notify you if your organization is meeting the requirements of OMB Circular A-122.