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["Florida Department of Education"]
["Risk Analysis"]
["Risk Analysis"]
["Federal and State Grant Funding"]
["Florida School Districts, State Colleges, State Universities and State Agencies"]
[]
["This form must be completed fully and accurately, including all attachments to be eligible to receive grant/project funding from the Department. All \"No or N/A\" responses require an explanation in the comment field. Should additional space be needed, a supplemental page which clearly identifies the applicable ID number on the form, should be included and placed behind the attachments. An original signature of the agency head who has legal authority to bind the Florida school district, state college, state university, or the state agency (hereafter referred to as the agency), and an original signature of the agency's head of financial management, is required. This form and attachments will remain in effect unless required by changes in federal or state law, other significant changes in circumstances affecting the financial and administrative capabilities of the agency or requested by the Department. A change in the agency head or the agency's head of financial management requires an amendment to this form.  Information submitted will be used to assess the financial and administrative capabilities to comply with requirements of grant/project funding.  In this evaluation an agency may be determined fundable but deemed \"high risk.\"  If determined \"high risk,\" special terms and conditions must be met as a condition for funding, and will be included on the Project Award Notification. In conjunction with this form, it is recommended that all employees of the agency that manage, directly or indirectly, grant/project awards complete the online DOE grants fiscal management training. "]
[]
[null,"Agency's Legal Name",{"$nulls":6},"FEIN Number"]
[null,"(Name must match registered name with DUNS)"]
[null,"(Please Type or Print)"]
[]
[null,"Name and Title of Agency Head"]
[null,"(Please Type or Print)"]
[null,"(Person legally authorized to bind the agency)"]
[]
[null,"Original Signature of Agency Head",{"$nulls":6},"Date"]
[null,"I certify that all the information provided on this application, and the documents attached are complete and correct to the best of my knowledge."]
[]
[null,"Name and Title of Agency's Head of Financial Management"]
[null,"(Please Print or Type)"]
[]
[null,"Original Signature of Agency's Head of Financial Management",{"$nulls":6},"Date"]
[]
["Submit completed or amended form with attachments to:"]
["FDOERiskAnalysis@fldoe.org"]
[]
[]
[]
["DOE 610 - revision 7/15/2022",{"$nulls":7},"Page 1 of 5"]
["ID","Risk Identification","Yes","No","N/A","Comments"]
[1,"Are the agency's organizational policies and procedures approved by the agency's Board?"]
[2,"Are annual operating budgets prepared, submitted to, and approved by the agency's Board prior to the start of each fiscal year?"]
[3,"Do organization's policies and procedures require prior Board approval for large purchases and all applications for projects, grants, contracts, subawards or subcontracts?"]
[4,"Does the agency's Board establish the salary ranges for all the agency's positions and approve salary increases for the Superintendent, President or Chief Executive Officer?"]
[5,"Has the agency received, operated or managed any state or federal funds in the last five years?"]
[6,"Has the agency ever had a government contract/project/agreement terminated? ",null,null,null,"If yes, explain:"]
[7,"Has the agency or any principals thereof ever been suspended or debarred from receiving state or federal grants or contacts?",null,null,null,"If yes, explain:"]
[8,"Has the agency or any principals thereof ever been the subject of a lawsuit or investigation alleging fraud, illegal activities or misappropriation of assets?",null,null,null,"If yes, explain:"]
[9,"Does the agency employ a finance director/officer with at least three years experience in accounting?"]
[10,"Has the agency experienced turnover in the following positions within the past year?"]
[null,"a.  Superintendent, President or Chief "]
[null,"     Executive Officer?"]
[null,"b.  Finance Director/Manager/Controller?"]
["DOE 610 - revision 7/15/2022",{"$nulls":7},"Page 2 of 5"]
["ID","Risk Identification","Yes","No","N/A","Comments"]
[11,"Does the agency maintain current formal written policies and procedures related to the following:"]
[null,"a.   Bank reconciliations"]
[null,"b.   Cash management"]
[null,"c.   Compensation and fringe benefits "]
[null,"d.   Confidentiality of records"]
[null,"e.   Conflicts of interest & disclosures"]
[null,"f.   Contract administration"]
[null,"g.   Determining allowability of cost"]
[null,"h.   Financial management"]
[null,"i.   Indirect cost rate development "]
[null,"j.   Payroll and time records"]
[null,"k.   Personnel policies and procedures"]
[null,"l.   Procurement"]
[null,"m. Method of conducting technical "]
[null,"     evaluations for competitive proposals"]
[null,"n.   Record retention requirements"]
[null,"o.   Travel"]
[null,"p.   Use of credit/debit cards"]
[12,"Does the agency maintain a fixed asset management system, with policies and procedures with the following components:"]
[null,"a.  Unique property identification number"]
[null,"b.  Date of acquisition "]
[null,"c.  Acquisition cost"]
[null,"d.  Description of property"]
[null,"e.  Location of property"]
[null,"f.  Maintenance"]
[null,"g.  Useful life and depreciation methods"]
[null,"h.  Asset protection (physical safeguards, "]
[null,"     insurance requirements, etc.)"]
[13,"Does the agency use an operating budget to control project funds?"]
[14,"Does the agency have a federally approved indirect cost rate? If yes, please include a copy of the plan, as attachment N. (N/A for school districts)"]
[15,"For staff working on a single federal cost objective, are semi-annual certifications maintained?"]
["DOE 610 - revision 7/15/2022",{"$nulls":7},"Page 3 of 5"]
["ID","Risk Identification","Yes","No","N/A","Comments"]
[16,"For staff working on two or more single federal cost objectives, are personnel activity reports maintained?"]
[17,"Is a complete personnel record kept on each person employed by the agency?"]
[18,"Do the agency's written policies require that employees' timesheets be signed by the employee and the employee's immediate supervisor?"]
[19,"Do travel expenditures require advance approval by an appropriate supervisor?"]
[20,"Does the agency maintain a code of conduct that governs the performance of its officers, employees or agents engaged in procurement which will help to avoid any conflict of interest?"]
["ATTACHMENTS",{"$nulls":7},"DOE USE ONLY"]
[{"$nulls":8},"Initial"]
["ID","(Please label each attachment as identified in the ID column)",{"$nulls":6},"Yes","No"]
["A ","Copy of the agency's registration with the Data Universal Numbering System (DUNS) "]
["B","Copy of the agency's registration with the System for Award Management (SAM)"]
["C","Copy of agency's current organizational chart"]
["D","Copy of agency's current policies and procedures to generate financial statements"]
["E","Copy of the agency's  policy and procedures on payroll cost and time and effort reporting"]
["F","Copy of agency's current policies and procedures for purchasing"]
["G","Copy of agency's current policies and procedures for fixed assets"]
["H","Description of agency's financial management system"]
["I","Copy of agency's current chart of accounts (N/A for school districts)"]
["J","Copy of federal approved indirect cost plan and approval documentation, if applicable. (N/A for school districts)"]
["DOE 610 - revision 7/15/2022",{"$nulls":7},"Page 4 of 5"]
["Risk Analysis"]
["Federal and State Grant Funding"]
["Florida School Districts, State Colleges and State Universities"]
[]
["FOR DOE USE ONLY"]
[]
["Office of Audit Resolution and Monitoring"]
[]
[]
["Recommend agency for funding"]
[{"$nulls":8},"Initial"]
["Recommend agency for funding as \"High Risk\""]
[{"$nulls":8},"Initial"]
["Agency \"Not Recommended for Funding\""]
[{"$nulls":8},"Initial"]
["Special Conditions for \"High Risk\" or"]
["Justification for \"Not Recommended"]
["for Funding\""]
[]
[]
[]
[null,null,"Signature",{"$nulls":5},"Date"]
[]
[]
[]
["Bureau Chief, Contract, Grants and Procurement"]
[]
["Agency Approved as Recommended"]
[{"$nulls":8},"Initial"]
["Agency is Approved with Special Conditions"]
[{"$nulls":8},"Initial"]
["Agency \"IS NOT\" Approved"]
[{"$nulls":8},"Initial"]
["Special Conditions or"]
["Justification for  \"Not Approved\""]
[]
[]
[null,null,"Signature",{"$nulls":5},"Date"]
[]
["DOE 610 - revision 7/15/2022",{"$nulls":7},"Page 5 of 5"]