INSTRUCTIONS FOR COMPLETION OF SF-SAC, REPORTING ON AUDITS
OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS
According to the Paperwork Reduction Act of 1995,
no persons are required to respond to a collection of
information unless it displays a valid OMB control
number. The valid OMB control number for this
information collection is OMB No. 0348-0057. The
time required to complete this data collection form
is estimated to average 30 hours for large auditees
(i.e., auditees most likely to administer a large
number of Federal awards) and 6 hours for all other
auditees. These amounts reflect estimates of
reporting burden on both auditees and auditors
relating to the data collection form, including the
time to review instructions, obtain the needed data,
and complete and review the information collection.
Office of Management and Budget (OMB) Circular A-133
(the Circular), "Audits of States, Local Governments, and
Non-Profit Organizations," requires non-Federal entities
that expend $300,000 or more in a year in Federal
awards to have an audit conducted in accordance with
the Circular.
The Circular (§__. 320(b)) requires auditees to submit a
completed Form SF-SAC (the form), along with other
specified reports, to the Federal clearinghouse
designated by OMB (currently the U.S. Bureau of the
Census). Auditees are also required to send a copy of the
reporting package (or written notification of no findings
(§__. 320(e)) to any pass-through entity from which they
receive Federal funds. Submissions to a pass-through
entity should not include the form.
DESCRIPTION OF FORM
PART I – GENERAL INFORMATION
The auditee shall complete this section (except
Items 4 and 7) and sign and date the
certification statement provided in Item 6 (g).
• Item 1 – Fiscal Year Ending Date For This
Submission
Enter the last day of the fiscal period covered
by the audit.
• Item 2 – Type of Circular A-133 Audit
Check the appropriate box. §__.200 of the
Circular requires non-Federal entities that
expend $300,000 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
Check 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).
SUBMISSION TO FEDERAL CLEARINGHOUSE
Only an approved version of the form will be
accepted. This means: an original or photocopy of the
form, or a document produced from the approved word
processing templates available at the website below.
The form must be signed and dated by both the auditee
and auditor. Submission of anything other than a
complete form and reporting package will not be
accepted.
WHO TO CONTACT WITH QUESTIONS
For audit related questions, please contact the Federal
awarding agency involved or the auditee’s Federal
cognizant or oversight agency. Appendix III of the
Compliance Supplement contains Federal agency contact
information for A-133 audits.
For questions concerning the submission process or the
form, contact the Federal Audit Clearinghouse
(1.888.222.9907). Information can also be found on the
Internet (http://harvester.census.gov/sac).
• Item 5 – Employer Identification Number (EIN)
(a) Auditee EIN
Enter the auditee EIN, which is the 9-digit
Taxpayer Identification Number assigned by the
Internal Revenue Service (IRS). Also, using the
spaces provided, enter the EIN on the top of
each page.
(b) Multiple EINs Covered in the Report
Check the appropriate box to indicate whether
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 separate EIN.) If yes, indicate
the principal EIN under 5 (a).
• Item 6 – Auditee Information
(a-f) Enter auditee information.
(g) A senior representative of the auditee (e.g.,
State controller, director of finance, chief
executive officer, chief financial officer) shall
sign the statement that the information on the
form is accurate and complete as required by
§__.320 of the Circular. Provide the name and
title of the signatory and date of signature.
FORMS WITHOUT ALL ITEMS COMPLETED WILL BE RETURNED TO THE AUDITEE
SF-SAC(I) (11-5-98)
INSTRUCTIONS FOR COMPLETION OF SF-SAC, REPORTING ON AUDITS OF STATES,
LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS – Continued
• Item 7 – Auditor Information
The auditor shall complete this item.
(a-f) Enter the name of the auditor that conducted the
audit in accordance with the Circular. The auditor
name may represent a sole practitioner, certified
public accounting firm, State auditor, etc. Where
multiple auditors or audit organizations are used
to conduct the audit work, the lead or coordinating
auditor shall provide their information in item 7
(a-f) and attach a sheet to the form with the same
information about other auditors.
(g) The auditor listed in Part I, Item 7 (a) shall be the
same auditor that signs the auditor statement.
Additional auditors may sign the form, but only the
first name listed will be entered into the database.
• Item 8 – Federal Cognizant or Oversight Agency
for Audit
Check the appropriate box. Auditees expending more
than $25 million a year have a Federal cognizant
agency. Auditees expending less than $25 million a
year have a Federal oversight agency.
• Item 9 – Name of Federal Cognizant or
Oversight Agency for Audit
Check the appropriate box to indicate the name of the
Federal cognizant or oversight agency for audit
determined in accordance with §__.400(a) or (b) of the
Circular. This will most often be the one Federal
awarding agency that provides the predominant
amount of direct funding. State and/or other
pass-through entities should not be listed. Cognizant
assignments are established every 5 years.
PART II – FINANCIAL STATEMENTS
The auditor shall complete this section of the form. All
information for this section should be obtained from
the audit reporting on the financial statements only.
PART III – FEDERAL PROGRAMS
The auditor shall complete this section of the form.
• Item 1 – Type of Audit Report on Major Program
Compliance
If the audit report on all major program compliance is
unqualified, check box 1. If the audit report for one or
more major programs is other than unqualified, check
boxes 2, 3, or 4, as applicable.
For example, if the audit report on major program
compliance for an auditee with three major programs
includes an unqualified opinion for one program, a
qualified opinion for the second program, and a
disclaimer of opinion for the third program, then check
boxes 2 and 4, but not 1 and 3.
• Item 2 – Dollar Threshold to Distinguish
Type A and Type B Programs
Enter the dollar threshold used to distinguish
between Type A and Type B programs as defined
in §_.520(b) of the Circular. The dollar threshold
must be $300,000 or higher. Please round to the
nearest dollar.
• Item 3 – Low-Risk Auditee
Indicate whether or not the auditee qualifies as a
low-risk auditee under §__.530 of the Circular.
• Item 4 – Audit Findings
Indicate whether or not the audit disclosed any
audit findings which the auditor is required to
report under §__.510(a) of the Circular A-133. If
marked Yes, the answers for Part III, Item 7 must
reflect the findings. If marked No, the answer for
Part III, Item 7 must not show any findings.
• Item 5 – Federal Agencies Required to Receive
the Reporting Package
Check the appropriate box to indicate each Federal
awarding agency required to receive a copy of the
reporting package pursuant to §__.320(d) of the
Circular. A Federal agency should be marked only
if the schedule of findings and questioned costs
disclosed audit findings relating to Federal awards
that the Federal awarding agency provided
directly OR the summary schedule of prior audit
findings reported the status of any audit findings
relating to Federal awards that Federal awarding
agency provided directly. If no Federal awarding
agency is required to receive a copy of the
reporting package, mark "None." Note that the
auditee must send the Clearinghouse one
reporting package for each Federal agency
selected in this question, plus one archival
reporting package.
• Item 6 – Federal Awards Expended
The information to complete columns (a), (b), and
(c) shall be obtained from the Schedule of
Expenditures of Federal Awards. It is important to
note that Item 6 shall include the required
information for each Federal program presented in
the Schedule of Expenditures of Federal Awards
(and notes thereto), regardless of whether audit
findings were reported. If additional space is
required, photocopy page 3 and attach the
additional page(s) to the form, and enter the total
for all pages in the "Total Federal Awards
Expended" block on the last page.
FORMS WITHOUT ALL ITEMS ANSWERED WILL BE RETURNED TO THE AUDITEE
SF-SAC(I) (11-5-98)
Page 2
INSTRUCTIONS FOR COMPLETION OF SF-SAC, REPORTING ON AUDITS OF STATES,
LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS – Continued
Column (a) – CFDA Number
Enter the number assigned to the Federal program
in the Catalog of Federal Domestic Assistance
(CFDA). Consult the Federal awarding agency or
pass-through entity to obtain this number.
For research and development programs that do
not have a CFDA number, enter the Federal
agency’s two-digit prefix (as listed in Appendix 1)
followed by a period and the letters "RD". For
example, an HHS research program would be
entered as "93.RD".
For other programs that do not have a CFDA
number, enter only the Federal agency’s two-digit
prefix (as listed in Appendix 1). For programs with
contract numbers, you may follow the two-digit
prefix with a period and the contract number. For
example, an HHS program with a contract number
would be entered as "93.999999999".
Column (b) – Name of Federal Program
Enter the name of the Federal program.
Column (c) – Amount of Federal Expenditures
Enter the amount of expenditures included in the
Schedule of Expenditures of Federal Awards
(Schedule) for each Federal program. It is
important to note that amounts shall be provided
for the value of Federal awards expended in the
form of non-cash assistance, the amount of
insurance in effect during the year, and loans or
loan guarantees outstanding at year end,
regardless of whether such amounts were
presented in the Schedule or in a note to the
Schedule. Please round to the nearest dollar.
• Item 7 – Audit Findings and Questioned
Costs
The rows of Item 7 directly correspond to matching
rows in Item 6. The information to complete
columns (a), (b), (c), (d) and (e) shall be obtained
from the Schedule of Findings and Questioned
Costs prepared by the auditor. If the Schedule of
Findings and Questioned Costs does not provide
information for a specific row and if there are no
audit findings, questioned costs, or internal control
findings, the auditor should mark O, N/A, C, and N/A
for items (b),(c),(d), and (e), respectively.
Column (a) – Major Program
Indicate whether or not the Federal program is
a major program, as defined in §_.520 of the
Circular.
Column (b) – Type of Compliance
Requirement
Using the list provided on the form in footnote
2 on page 3, enter the letters that correspond to
the type(s) of compliance requirements
applicable to the audit findings and questioned
costs reported for each Federal program. Do not
list all compliance requirements that were
tested. If there were no audit findings or
questioned costs, enter O for "None".
Column (c) – Questioned Costs
Enter the amount of questioned costs by
Federal program. If no questioned costs were
reported, enter N/A for "Not Applicable." Please
round to the nearest dollar.
Column (d) – Internal Control Findings
Check the appropriate box, using the list
provided on the form in footnote 3 on page 3,
that corresponds to the internal control findings
that apply to the Federal program. If all findings
for the program are Material Weaknesses, enter
A. If findings for the program include some
Reportable Conditions that are Material
Weaknesses and some Reportable Conditions
that are not, enter A and B. If findings for the
program include only Reportable Conditions
that are not Material Weaknesses, enter B. If
there are no findings for the program, enter C
for "None Reported."
Column (e) – Audit Finding Reference
Number(s)
Enter the audit finding reference number(s) for
audit findings included in the Schedule of
Findings and Questioned Costs. If no audit
findings were reported, enter N/A for "Not
Applicable."
Please note that Part III, Item 4 and Part III, Item 7
are directly related. If Item 4 indicates findings,
then Item 7 must indicate findings. If Item 4
indicates no findings, then all items in Item 7 must
indicate no findings.
FORMS WITHOUT ALL ITEMS ANSWERED WILL BE RETURNED TO THE AUDITEE
SF-SAC(I) (11-5-98)
Page 3
APPENDIX 1
Federal AgencyTwo-Digit Prefix List
01 African Development Foundation
02 Agency for International Development
10 Department of Agriculture
23 Appalachian Regional Commission
88 Architectural & Transportation Barriers
Compliance Board
13 Central Intelligence Agency
11 Department of Commerce
29 Commission on Civil Rights
78 Commodity Futures Trading Commission
87 Consumer Product Safety Commission
94 Corporation for National & Community Service
12 Department of Defense
84 Department of Education
81 Department of Energy
66 Environmental Protection Agency
30 Equal Employment Opportunity Commission
32 Federal Communications Commission
83 Federal Emergency Management Agency
33 Federal Maritime Commission
34 Federal Mediation and Conciliation Service
18 Federal Reserve System
36 Federal Trade Commission
39 General Services Administration
40 Government Printing Office
93 Department of Health and Human Services
14 Department of Housing and Urban Development
03 Institute for Museum Services
04 Inter-American Foundation
15 Department of Interior
61 International Trade Commission
41 Interstate Commerce Commission
16 Department of Justice
17 Department of Labor
09 Legal Services Corporation
42 Library of Congress
91 Miscellaneous Foundations & Commissions
99 Miscellaneous
43 National Aeronautics & Space Administration
89 National Archives & Records Administration
92 National Council on Disability
44 National Credit Union Administration
05 National Endowment for the Arts
06 National Endowment for the Humanities
68 National Gallery of Art
46 National Labor Relations Board
47 National Science Foundation
77 Nuclear Regulatory Commission
07 Office of National Drug Control Policy
27 Office of Personnel Management
70 Overseas Private Investment Corporation
08 Peace Corps
86 Pension Benefit Guaranty Corporation
22 Postal Service
53 President’s Committee on Employment of
the Handicapped
57 Railroad Retirement Board
85 Scholarship Foundations
58 Securities and Exchange Commission
59 Small Business Administration
60 Smithsonian Institution
96 Social Security Administration
19 Department of State
62 Tennessee Valley Authority
20 Department of Transportation
21 Department of Treasury
82 United States Information Agency
64 Department of Veterans Affairs
FORMS WITHOUT ALL ITEMS ANSWERED WILL BE RETURNED TO THE AUDITEE
SF-SAC(I) (11-5-98)
Page 4
OMB No. 0348-0057
FORM
(8-97)
SF-SAC
U.S. DEPARTMENT OF COMMERCE - BUREAU OF THE CENSUS
ACTING AS COLLECTING AGENT FOR
OFFICE OF MANAGEMENT AND BUDGET
Data Collection Form for Reporting on
AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS
▲
RETURN TO
Complete this form, as required by OMB Circular A-133, "Audits
of States, Local Governments, and Non-Profit Organizations."
PART I
GENERAL INFORMATION (To be completed by auditee, except for Item 7)
1. Fiscal year ending date for this submission
Month
Day
/
/
2. Type of Circular A-133 audit
Year
1
3. Audit period covered
Annual
Biennial
1
2
Single Audit Clearinghouse
1201 E. 10th Street
Jeffersonville, IN 47132
3
Other –
Single audit
FEDERAL
GOVERNMENT
USE ONLY
Months
2
Program-specific audit
4. Date received by Federal
clearinghouse
5. Employer Identification Number (EIN)
a. Auditee EIN
b. Are multiple EINs covered in this report?
1
Yes
7. AUDITOR INFORMATION (To be completed by auditor)
6. AUDITEE INFORMATION
a. Auditee name
a. Auditor name
b. Auditee address (Number and street)
b. Auditor address (Number and street)
City
City
State
ZIP Code
State
Name
Name
Title
Title
d. Auditor contact telephone
d. Auditee contact telephone
)
ZIP Code
c. Auditor contact
c. Auditee contact
(
No
2
–
(
)
–
e. Auditee contact FAX (Optional)
e. Auditor contact FAX (Optional)
f. Auditee contact E-mail (Optional)
f. Auditor contact E-mail (Optional)
g. AUDITEE CERTIFICATION STATEMENT – This is
g. AUDITOR STATEMENT – The data elements and
(
)
–
(
to certify that, to the best of my knowledge and
belief, the auditee has: (1) Engaged an auditor to
perform an audit in accordance with the provisions of
OMB Circular A-133 for the period described in Part I,
Items 1 and 3; (2) the auditor has completed such
audit and presented a signed audit report which
states that the audit was conducted in accordance
with the provisions of the Circular; and, (3) the
information included in Parts I, II, and III of this data
collection form is accurate and complete. I declare
that the foregoing is true and correct.
Signature of certifying official
Date
Month
/
Name/Title of certifying official
Day
Year
/
)
–
information included in this form are limited to those
prescribed by OMB Circular A-133. The information
included in Parts II and III of the form, except for Part
III, Items 5 and 6, was transferred from the auditor’s
report(s) for the period described in Part I, Items 1
and 3, and is not a substitute for such reports. The
auditor has not performed any auditing procedures
since the date of the auditor’s report(s). A copy of the
reporting package required by OMB Circular A-133,
which includes the complete auditor’s report(s), is
available in its entirety from the auditee at the
address provided in Part I of this form. As required by
OMB Circular A-133, the information in Parts II and
III of this form was entered in this form by the auditor
based on information included in the reporting
package. The auditor has not performed any
additional auditing procedures in connection with the
completion of this form.
Signature of auditor
Date
Month
/
Day
Year
/
EIN:
PART I
GENERAL INFORMATION – Continued
8. Indicate whether the auditee has either a Federal cognizant or oversight agency for audit. (Mark (X) one box)
Cognizant agency
Oversight agency
1
2
9. Name of Federal cognizant or oversight agency for audit (Mark (X) one box)
01
02
10
11
94
12
84
81
66
African Development
Foundation
Agency for
International
Development
Agriculture
Commerce
Corporation for
National and
Community Service
Defense
Education
Energy
Environmental
Protection Agency
PART II
83
34
39
93
14
03
04
15
Federal Emergency
Management Agency
Federal Mediation and
Conciliation Service
General Services
Administration
Health and Human
Services
Housing and Urban
Development
Institute for Museum
Services
Inter-American
Foundation
Interior
16
17
43
89
05
06
47
07
Justice
Labor
National Aeronautics
and Space
Administration
National Archives and
Records Administraton
National Endowment
for the Arts
National Endowment
for the Humanities
National Science
Foundation
Office of National Drug
Control Policy
59
96
19
20
21
82
64
Peace Corps
Small Business
Administration
Social Security
Administration
State
Transportation
Treasury
United States
Information Agency
Veterans Affairs
Other – Specify:
FINANCIAL STATEMENTS (To be completed by auditor)
1. Type of audit report (Mark (X) one box)
Unqualified opinion
Qualified opinion
2
1
3
Adverse opinion
2. Is a "going concern" explanatory
paragraph included in the audit report?
1
Yes
2
No
3. Is a reportable condition disclosed?
1
Yes
2
No – SKIP to Item 5
4. Is any reportable condition reported
as a material weakness?
1
Yes
2
No
5. Is a material noncompliance disclosed?
1
Yes
2
No
PART III
08
4
Disclaimer of opinion
FEDERAL PROGRAMS (To be completed by auditor)
1. Type of audit report on major program compliance
Unqualified opinion
1
2
Qualified opinion
3
Adverse opinion
4
Disclaimer of opinion
2. What is the dollar threshold to distinguish Type A and Type B programs §___ .520(b)?
$
3. Did the auditee qualify as a low-risk auditee (§___ .530)?
1
Yes
No
2
4. Are there any audit findings required to be reported under §___ .510(a)?
1
Yes
2
No
5. Which Federal Agencies are required to receive the reporting package? (Mark (X) all that apply)
01
African Development 83
Federal Emergency
16
Peace Corps
Justice
08
Foundation
Management Agency
17
Labor
Small Business
59
02
Agency for
34
Federal Mediation and
Administration
43
National Aeronautics
International
Conciliation Service
Social Security
and Space
96
Development
Administration
39
General Services
Administration
Agriculture
Administration
10
State
National Archives and
89
19
93
Commerce
Health and Human
Records Administraton 20 Transportation
11
Services
Corporation for
National Endowment
94
05
Treasury
21
Housing and Urban
14
National and
for the Arts
82
United States
Development
Community Service
06
National Endowment
Information Agency
Defense
03
12
for the Humanities
Institute for Museum
Veterans Affairs
64
Services
Education
National Science
84
47
00
None
Foundation
Inter-American
04
Energy
81
Other – Specify:
Foundation
Office of National Drug
07
66
Environmental
Control Policy
Interior
15
Protection Agency
FORM SF-SAC (8-97)
Page 2
FEDERAL PROGRAMS – Continued
FORM SF-SAC (8-97)
(b)
(a)
$
$
$
$
$
$
$
$
$
$
$
(c)
Amount
expended
$
$
$
$
$
$
$
$
$
$
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
(b)
Type of
compliance
requirement2
(c)
Amount of
questioned
costs
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
3 Type
of internal control findings (Mark (X) all that apply)
A. Material weaknesses
B. Reportable conditions
A
B
A
B
A
B
A
B
A
B
A
B
A
B
A
B
A
B
A
B
3
3
3
3
3
3
3
3
3
3
(d)
C
C
C
C
C
C
C
C
C
C
(e)
Internal Audit finding
reference
control
findings3 number(s)
IF ADDITIONAL LINES ARE NEEDED, PLEASE PHOTOCOPY THIS PAGE,
ATTACH ADDITIONAL PAGES TO THE FORM, AND SEE INSTRUCTIONS
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
(a)
Major
program
7. AUDIT FINDINGS AND QUESTIONED COSTS
C. None reported
other identifying number when the Catalog of Federal Domestic Assistance (CFDA) number is not available.
of compliance requirement (Enter the letter(s) of all that apply to audit findings and questioned costs reported for each Federal program.)
L. Reporting
A. Activities allowed or unallowed
G. Matching, level of effort, earmarking
M. Subrecipient monitoring
B. Allowable costs/cost principles
H. Period of availability of funds
N. Special tests and provisions
C. Cash management
I. Procurement
J. Program income
O. None
D. Davis - Bacon Act
K. Real property acquisition and
E. Eligibility
F. Equipment and real property management
relocation assistance
2 Type
1 Or
TOTAL FEDERAL AWARDS EXPENDED
Name of Federal
program
CFDA
number 1
6. FEDERAL AWARDS EXPENDED DURING FISCAL YEAR
PART III
EIN:
Page 3
