Form SF-SAC Worksheet & Single Audit Component Checklist For Audits With Fiscal Periods Ending in 2013

Enter and Submit Form SF-SAC data and Single Audit package only at:

- 1 -

AUDIT COMPONENTS REQUIRED FOR SINGLE AUDIT SUBMISSION:

Single Audit Component Checklist

Attention: Please review your audit report to make sure that Personally Identifiable Information, or PII, is not included. Examples of PII are, but not limited to, Social Security Numbers, account numbers, vehicle identification numbers, copies of cancelled checks, student names, dates of birth, personal addresses or personal phone numbers.

___________________________________________________________________________________________

Please enter the starting pdf file page number for each of the following components. If auditor reports have been completed, then list the starting page number of the combined report for each corresponding report on the checklist. If a component is not required, enter 'N/A' instead of a page number. Each component on the checklist must have a numeric page number or 'N/A' listed.

The following is a key for the Component Checklist * = Required (cannot be blank or 'N/A'). ** = Required if prior audit findings exist. *** = Required if findings exist. Note: These codes do not apply to a program specific audit..

Page Number Component

* Financial Statement(s) §__ .310(a)

* Opinion on Financial Statements §__ .505(a)

* Schedule of expenditures of Federal Awards §__ .310(b)

* Opinion or Disclaimer of Opinion on Schedule of Federal Awards §__ .505(a)

* A-133 Report on Internal Control §__ .505(b) (major programs)

* A-133 Report on Compliance §__ .505(c) (major programs)

* GAS Report on Internal Control §__ .505(b)

* GAS Report on Compliance §__ .505(c)

* Schedule of Findings and Questioned Costs §__ .505(d)

** Summary Schedule of Prior Audit Findings §__ .315(b)

*** Corrective Action Plan (if findings) §__ .315(c)

FORM SF-SAC 12/31/2013 U.S. Dept. of Comm. - Econ and Stat Admin. - U.S. Census Bureau

OMB No. ACTING AS COLLECTING AGENT FOR OFFICE OF MANAGEMENT AND BUDGET

PART I: GENERAL INFORMATION REPORT ID: VERSION: 1. Fiscal Period End Date 2. Type of Circular A-133 audit

__ __ / __ __ /__ __ __ __ Single Audit

MM / DD / YYYY Program-specific audit

3. Audit Period Covered Annual

Biennial

Other- If Other, Number of months:

4. Auditee Identification Numbersa. Auditee Employer Identification Number (EIN) d. Auditee Data Universal Numbering System (DUNS) Number

__ __ - __ __ __ __ __ __ __ __ __ - __ __ __ - __ __ __ __

b. Are multiple EINS covered in this report? e. Are multiple DUNS covered in this report? Yes If Yes, complete Part I, Item 4c: Yes If Yes, complete Part I, Item 4f:

Auditee EIN Continuation Sheet Auditee DUNS Continuation Sheet.

No No5. Auditee Information 6. Primary Auditor Informationa. Auditee name a. Audit Firm/Organization Name

b. Auditee address (Number and street) b. Audit Firm/Organization EIN__ __ - __ __ __ __ __ __ __

c. Audit Firm/Organization address

Auditee City Audit Firm/Organization City

Auditee State Audit Firm/Organization State

Auditee ZIP Code Audit Firm/Organization ZIP Code

c. Auditee Contact Name d. Primary Auditor Contact Name

Auditee Contact Title Primary Auditor Contact Title

d. Auditee Contact Telephone e. Primary Auditor Contact Telephone

e. Auditee Contact Fax f. Primary Auditor Contact FAX

f. Auditee Contact E-mail g. Primary Auditor Contact E-mail

7. Was a secondary auditor used? Yes- If Yes, Complete Part I, Item 8 on the

Secondary Auditor Contact Information Sheet No

Data Collection Form for Reporting onAUDITS OF STATES, LOCAL GOVERNMENTS AND NON-PROFIT ORGANIZATIONS

For Fiscal Year Ending Dates in 2013, 2014, or 2015

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Form SF-SAC REPORT ID: VERSION:PART II: FINANCIAL STATEMENTS (To be completed by auditor)1.Type of audit reportMark either: Unmodified Opinion OR ANY COMBINATION OF: Qualified opinion

Adverse opinion Disclaimer of opinion

2. Is a "going concern" emphasis-of-matter paragraph included in the audit report? Yes No

3. Is a significant deficiency disclosed? Yes No

4. Is a material weakness disclosed? Yes No

5. Is a material noncompliance disclosed? Yes No

1. Does the auditor's report include a statement that the auditee's financial statements include departments, agencies, or other organizational units expending $500,000 or more in Federal awards that have separate A-133 audits which are not included in this audit? (AICPA Audit Guide) Yes No

2. What is the dollar threshold to distinguish Type A and Type B programs? (OMB Circular A-133 § _.520(b)) $ _______________________

3. Did the auditee qualify as a low-risk auditee? (§_.530) Yes No

4. Were Prior Audit Findings related to direct funding shown in the Summary Schedule of Prior Audit Findings? (§_.315(b)) Yes No

98 U.S. Agency for International Development 17 Labor10 Agriculture 09 Legal Services Corporation23 Appalachian Regional Commission 43 National Aeronautics and Space Administration11 Commerce 89 National Archives and Records Administration94 Corporation for National and Community Service 05 National Endowment for the Arts12 Defense 06 National Endowment for the Humanities84 Education 47 National Science Foundation81 Energy 07 Office of National Drug Control Policy66 Environmental Protection Agency 59 Small Business Administration39 General Services Administration 96 Social Security Administration93 Health and Human Services 19 U.S. Department of State97 Homeland Security 20 Transportation14 Housing and Urban Development 21 Treasury03 Institute of Museum and Library Science 64 Veterans Affairs15 Interior 00 None16 Justice OTHER - SPECIFY:

PART III: FEDERAL PROGRAMS (To be completed by auditor)

5. Indicate which Federal Agency(ies) have current year audit findings related to direct funding or prior audit findings shown in the Summary Schedule of Prior Audit Findings related to direct funding. Mark (X) all that apply or None .

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FORM SF-SAC REPORT ID: VERSION: CERTIFICATIONS

Auditee Certification Statement Auditor StatementThis is 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.

The data elements and information included in this form are limited to those prescribed by OMB Circular A-133. Except for Part III, Items 4, 5, 6a-6h, and, when audit findings are reported, 7a-7c, the information included in Parts II and III of this form 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.

Auditee Certification Auditor Signature(Date of Electronic Signature ) (Date of Electronic Signature )

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FORM SF-SAC REPORT ID: VERSION:

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FORM SF-SACPART I, Item 4f. AUDITEE DUNS CONTINUATION SHEET (FROM PART I, ITEM 4e)List the multiple DUNS covered in this report.

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