Vermont Department of Public Safety
Risk Management Survey

Welcome to the Vermont Department of Public Safety’s (DPS) Risk Assessment. As an applicant for an award from DPS, each organization* must complete this survey annually. This risk assessment should be a true evaluation of your organization’s internal controls. Prior to issuance of a grant award, State of Vermont granting agencies must determine if each potential grantee is eligible to receive an award (Vermont Agency of Administration Bulletin No. 5). DPS will use this tool to evaluate each subrecipient's risk of noncompliance with federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate method of subrecipient monitoring (2 CFR §200.331 (b)).

*For example, "ABC Town" should submit, however "ABC Police Department" or "ABC Fire Department" would not be required to submit separately if they are the same entity.

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* Organization Name

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* Organization Information

DUNS #

FEIN

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* Your Fiscal Year (e.g. July - June or Jan. - Dec.)

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* Legal name (parent, fiduciary) of entity to which the FEIN was assigned, if applicable

It is recommended that this survey be completed by a financial/accounting representative of the organization such as: Financial Manager, Treasurer, Bookkeeper, Accounting Administrator

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* Survey completed by

Name

Title

Mailing Address

E-Mail Address

Phone Number

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* Physical address as listed on SAM.gov

Address

Address 2

City/Town

State

Zip Code

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* Ensure the DUNS number been registered with the System for Award Management (SAM) at https://www.sam.gov/portal/public/SAM/?

provide expiration date

Date

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* Type of Organization

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* 1. What type of accounting system do you use?

Automated

Manual

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* 2. Does your organization have a segregation of duties so no single person has control over all phases of a transaction?

Yes

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* 3. Does your organization maintain its award documentation for at least 3 years after close-out?

Yes

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* 4. Does your organization include financial/accounting personnel in the application review process to ensure that you can meet all compliance requirements?

Yes

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* 5. Has your organization been audited or had a grant monitoring review within the past 24 months? Please select all that apply.

No, not within the past 24 months, skip to question 7

Yes, by an outside audit firm

Yes, by town/local auditors

Yes, by the State of Vermont

Yes, by a federal auditor

Yes, a Single Audit was performed

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* 6.Did your organization have any findings?

No, the audit produced no findings

Yes, however audit findings have been resolved

Yes, and our organization has outstanding unresolved findings

Yes, and our organization has an active corrective action plan for our audit findings

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* 7. Does your organization maintain written policies which included procedures for assuring compliance with the terms and conditions as noted in the Department of Public Safety's Standard Grant Agreement? Copies must be made available upon request. Select all that apply.

Written Grant Management Policy

Written Purchasing Procedures (2 CFR §200.319 (c))

Written Conflict of Interest Policy (2 CFR §200.318 (c)(1))

Written Inventory Policy

Written Employee Policy (Personnel Polices & Procedures/Bargaining Agreements)

Written Payroll Policy

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* 8 Has there been any of the following changes at your organization within the past 12 months?

New personnel who will be administering this grant funding

New or substantially changed systems that would affect grant management

Below is a short list of state & federal grant requirements, this is not a comprehensive list of requirements. Please refer to your grant agreement for the full list of requirements.

State of Vermont Department of Public Safety Grant Agreement:

May not supplant (replace) local or state funds (Attachment B)

Maintain records to detail the history of procurement, for example: bid solicitations, written selection procedures, adequate number of bids/quotes, purchase orders, invoices, reimbursement requests, bank statements for all checks, and personnel activity reporting (Attachment B)

Will submit for reimbursement no later than the end of the month following the month in which the expenses were incurred (Attachment C)

Can comply with the insurance requirements in Attachment C

Only subcontract or subaward with written approval from the State (Attachment C)

Will provide written notification of organizational change within 30 days (Attachment D)

Federal funding compliance measures based on 2 CFR 200 Uniform Administrative Requirements:

All procurement transactions will provide for full and open competition (2 CFR §200.319 (a))

Will provide written procedures for procurement transactions to include all product/service requirements (2 CFR §200.319 (c))

Will adequately identify in your accounts all federal award revenue and expense (2 CFR §200.302 (b)(1))

Will maintain property records (2 CFR §200.313 (d)(1)) for equipment (2 CFR §200.319 (c))

Will maintain personnel expense records which meet the standards for documentation (2 CFR §200.403)

An applicant for Federal awards must disclose in writing any potential conflict of interest to the Federal awarding agency or pass-through entity in accordance with applicable Federal awarding agency policy (2 CFR §200.113)

PLEASE READ BEFORE SUBMITTING SURVEY: Once the survey has been submitted you will not be able to print it. If you would like to print this survey for your records you may do so now by selecting "File", "Print Preview" and then "Print". If you print without going to Print Preview first the whole survey may not print.

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* Your electronic signature on this agreement attest to the accuracy of the information. Supporting documentation must be provided to the Vermont Department of Public Safety upon request.

I agree to the validity of all responses and acknowledge that our organization will be held accountable for auditing purposes