Peer Review Reporting Form (Pr-1) - State Of California
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4PEER REVIEW REPORTING FORM
LICENSEE/FIRM INFORMATION
1. Licensee/Firm Name:
2. Business
3. Business E-mail
Telephone #:
Address:
4. License
5. License
Number:
Expiration Date:
6. Does the licensee operate as an accounting firm?
:
(Check one below and go to number 15)
(Select firm type below, then go to
NO
YES
:
number 7)
Employee, partner or shareholder of an accounting
Sole Proprietorship
firm
General Partnership
Employee, partner or shareholder of a
Limited Liability Partnership
non-accounting firm
Corporation
Employee of the government
Unemployed or retired
Other________________________________
1
2
3
4
7.
Number of shareholders, partners, owners, and full-
time licensees of the firm:
5-10
11-99
100+
Yes
(Go to number 8b.)
8a. Has the firm performed accounting and auditing services, as defined in
Section 39(a) of Title 16 of the California Code of Regulations, that
No
(Go to number 15.)
require a peer review since the last license renewal?
8b. If the firm completed its first accounting and auditing service within 18 months
prior to the expiration date of the license, indicate the date the service was
completed:
(NOTE: The firm must have a peer review report accepted by a Board-recognized
(If applicable, go to
peer review program provider within 18 months of this date and report the results at
number 15. If not
the time of the next renewal.)
applicable, go to
number 9.)
PEER REVIEW INFORMATION
9.
Date Last Peer Review Report Accepted:
Pass
(Go to question 11a.)
10a. Peer Review Report Rating:
Pass w/deficiencies
(Go to question 11a.)
Substandard
(Go to question 10b.)
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