Form Sf-Sac - Audits Of States, Local Governments, And Non-Profit Organizations (Page 6 of 14) in pdf

DESCRIPTION OF FORM

PART I - GENERAL INFORMATION

The auditee completes this section (except Items 4 and 7) and signs and dates the certification statement

provided in Item 6(g). The auditor completes Item 7 and signs and dates the statement provided in Item 7(g).

Item 1 - Fiscal Period Ending Date For This Submission

Enter the last day of the fiscal period covered by the audit. The 2004 Form applies to all audits covering

fiscal periods ending in the 2004, 2005 or 2006 calendar years.

Note: Submissions covering fiscal period end dates prior to January 1, 2004 should use one of

the prior versions of Form SF-SAC available on the Federal Audit Clearinghouse Web site

( ). The form dated 3-20-2001 should be used for audits covering

fiscal periods ending in 2001, 2002 or 2003. The form dated 8-97 should be used for audits

covering fiscal periods ending in 1997, 1998, 1999 or 2000.

Item 2 - Type of Circular A-133 Audit

Mark (X) the appropriate box. §__.200 of the Circular requires non-Federal entities that expend $500,000 or

more in a year in Federal awards to have a single audit conducted in accordance with §__.500, except when

they elect to have a program-specific audit conducted in accordance with §__.235.

Item 3 - Audit Period Covered

Mark the appropriate box. Annual audits cover 12 months and biennial audits cover 24 months. If the audit

period covered is neither annual nor biennial, mark "Other" and provide the number of months (excluding

12 and 24) covered in the space provided.

Item 4 - Date Received by Federal Clearinghouse

Skip this item (Federal government use only).

Item 5 - Auditee Identification Numbers

(a) Primary Employer Identification Number (EIN)

Enter the Auditee’s Employer Identification Number (EIN), the nine-digit taxpayer identification number

assigned by the Internal Revenue Service (IRS). If the auditee was assigned multiple EINs, enter the primary

EIN. Also, using the spaces provided, enter the primary EIN on the top of each page of the form.

(b) Are Multiple EINs Covered in this Report

Mark (X) the appropriate box to indicate if the auditee (or components of an auditee covered by the audit)

was assigned more than one EIN by the IRS. (Example: A Statewide audit covers many departments, each

of which may have its own EIN.)

If Part I, Item 5(b) is marked "Yes" list the additional EIN numbers for all entities covered by the audit in

Item 5(c) of the continuation sheet on page 4 of the Form SF-SAC. An EIN should be considered covered in

this report if this report is intended to satisfy the entity’s or component’s (e.g., State Agency, subentity)

single audit requirement. If additional lines are needed, photocopy page 4 and attach the additional page(s)

to the form. Do not include separate EINs for any component which did not receive, expend, or otherwise

administer Federal awards. Do not include the primary EIN in Item 5(c) of the continuation list.

Note: Auditees may file the continuation sheet on page 4 via an electronic spreadsheet using the online

submission option. Instructions for this option are included in the online filing instructions available on

the FAC Web site.

(d) Data Universal Numbering System (DUNS) Number

The Data Universal Numbering System (DUNS) number is a unique nine-digit identification sequence

assigned by Dun & Bradstreet (D&B) and is required by OMB policy on all Federal award applications

submitted on or after October 1, 2003. All primary applicants, i.e., the entity making the application to the

Federal government, including states, local, and tribal governments, and other entities receiving block or

other mandatory grants will need a DUNS number to apply for funds. A DUNS number is required from

these direct applicants for all Form SF-SAC submissions effective starting with fiscal periods ending in 2005.

Although not required by sub-grantees, a DUNS number is requested for all Form SF-SAC submissions

effective starting with fiscal periods ending in 2005.

The primary auditee’s DUNS number should be entered in Item 5(d). However, auditees who used the

financial services of another entity for the administration or processing of Federal awards should enter that

entity’s DUNS number in Item 5(d) as the primary DUNS number. While items 5(d), (e), and (f) may be left

blank if the auditee is reporting only pass-through Federal award expenditures, this data is requested.

SF-SAC(I) (5-2004)

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Form Sf-Sac - Audits Of States, Local Governments, And Non-Profit Organizations Page 6

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