Audit Certification

Audit Certification Form

Single Audit Act Amendments of 1996
In accordance with 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements, found in §200.501(a), audit requirements for Federal awards, non-federal entities that expend $750,000.00 or more in federal awards from all federal funding sources during their fiscal year, must agree to have a Single Audit Conducted in accordance with §200.514 Scope of Audit. Further, §200.512 requires that the final report for such audit be completed within nine (9) months of the entity's fiscal year end.
Directions:
Your entity's Chief Financial Officer, or other official authorized to certify financial documents, must certify whether or not your organization is subject to the Single Audit requirement according to the above citations by completing the information below, checking the appropriate boxes in Sections A and B, and signing and dating the form. Submission of this form prior to the fiscal year end is permitted; however, if unanticipated Federal funding is received by your entity, bringing the expended amount of federal funding above $750,000.00, you must submit a revised Audit Certification Form and include the Single Audit report.
Subrecipient (community/agency)*
Fiscal Year*
Month
Day
Year
Federal Program*
Section A - Select the applicable option*
Explain Below:
Section B - Complete if a Single Audit is required.
Our Single Audit will be completed on:*
MM slash DD slash YYYY
Our Single Audit will be submitted to HSEM by:*
MM slash DD slash YYYY
Single Audit
Drop files here or

Max. file size: 1 GB.
Upload a copy of the Single Audit for the fiscal year identified above.
By Selecting the Box Below and entering my name and today's date, I certify that I am an individual authorized to complete this form. I further certify that the above information is accurate and, if required, the audit report will be submitted no later than nine (9) months after the fiscal year ending noted above.*
- Certification
Name*
Title*
Submission Date*
MM slash DD slash YYYY
Email*
Enter Email Confirm Email

Audit Certification

Audit Certification Form

Single Audit Act Amendments of 1996

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