INSTRUCTIONS: Subrecipient Entity Certification Form – Domestic and Foreign
This form is not required if the entity is a participating member of the FDP Clearinghouse.
The Entity Certification form should be completed when subrecipient entities do not exist in SAGE, and every three years or upon OSP request.
There is one certification form for New Domestic Subrecipients and a different form for New Foreign Subrecipients. These instructions cover both forms.
The Domestic and Foreign Subrecipient Entity Certification forms should be completed by someone who is knowledgeable about your organization’s business details, systems and processes. It should not be completed in relation to any specific project or subaward/subcontract.
The forms also must be approved and signed by your organization’s authorized institutional official.
Organization Information
Organization Legal Name:
This is the legal name of the subrecipient organization that is used for all official purposes. It should not be a nickname. The legal name should be the name of the legal entity authorized to enter into contracts on behalf of the organization, not a sub-unit of that organization.
Official Address:
Domestic Form: Enter the physical address along with the Zip code plus four digits for the organization.
Foreign Form: Enter the physical address along with the the Postal Code for the organization.
Organization Type:
Check the boxes that describe the type of organization. Check all the options that apply.
Example: A non-profit University would check the box for “Non-Profit” and “Higher Education”
Fiscal Year End Date:
The month and day for the fiscal year end. Example: If the organization’s fiscal year is from July 1 to June 30, June 30 would be entered.
EIN Number - Domestic Form Only:
Enter the Employer Identification Number (EIN) for the organization. An EIN is also known as a Federal Tax Identification Number and is used to identify a business entity in the United States.
Unique Entity Identifier:
Check the box next to “YES” if the organization has obtained a Unique Entity Identifier (UEI) from SAM.gov and enter the UEI in the space provided. Check the box next to “NO” if the organization has not obtained a UEI.
Note: The organization must provide UEI obtained from SAM.gov prior to receiving subaward under federal funds from University of Washington, in accordance with 2 CFR 25.300.
Section A - Certifications
Facilities and Administrative (F&A) Rates:
Facilities and Administrative Rates are the percentage of the project’s direct costs that an organization may charge the sponsor for the “indirect” costs associated with housing and managing a sponsored project.
Organization has a Federally-negotiated F&A rate:
Check this box if organization has a federally established rate that an agency of the U.S. federal government has negotiated with the organization after reviewing its indirect cost proposal and has agreed in writing that the organization may charge the U.S. federal government a set percentage of direct project costs for F&A (indirect) costs. Attach a copy of the current rate agreement with this form.
Organization does not have a Federally-negotiated rate:
Check this box if the organization does not have a federally established rate and accepts rate limitations governed by Prime Funding Agencies or the 10% de minimis MTDC rate as a Subrecipient per 2 CFR 200.414 (f).
Other Rates:
Check this box if your organization does not have a U.S. federally negotiated F&A rate and plans to charge for indirect costs, please add a description of the basis on which the rate has been calculated in the space provided.
Fringe Benefit Rates:
Fringe benefit rates include the percentage of salary and/or the amount your organization pays for employee retirement, health insurance, Medicare, and Social Security, etc. It represents the employer’s contribution to these costs—not the employee’s contribution.
- Organization has a Federally-negotiated fringe benefit rates: Check this box if organization has federally established fringe benefit rates that an agency of the U.S. federal government has negotiated with the organization. Attach a copy of the current rate agreement with this form.
- Organization uses Actual fringe benefit rates: Check this box if the organization uses actual fringe benefit rates and does not have federally established fringe benefit rates.
- Other Rates: Check this box if your organization does not have a U.S. federally negotiated fringe benefit rates or use actual fringe benefit rates. Please add a description of the basis on which the rates have been calculated in the space provided.
NSF Conflict of Interest Compliance:
The National Science Foundation (NSF) requires each recipient organization employing more than fifty persons to maintain an appropriate written and enforced policy on conflict of interest and that all conflicts of interest for each award be managed, reduced, or eliminated prior to the expenditure of the award funds. The full requirements can be found in Chapter IX.A NSF’s Proposal & Award Policies & Procedures Guide.
Check the box for YES if the organization has a policy compliant with the NSF regulations and add a link to the policy in the space provided.
Check the box for NO if the organization does not have a policy compliant with the NSF regulations. Checking this box indicates the organizations agreement to abideby the UW’s Conflict of Interest policy when receiving NSF funded subawards from the UW
NASA Conflict of Interest Compliance:
The National Aeronautics and Space Administration (NASA) requires each recipient maintain written standards of conduct governing the performance of its employees engaged in the award and administration of grants and cooperative agreements. The full requirements can be found in Section 3.3 of the Grants and Cooperative Agreements Manual.
Check the box for YES if the organization has a policy compliant with the NASA regulations and add a link to the policy in the space provided.
Check the box for NO if the organization does not have a policy compliant with the NASA regulations. Checking this box indicates the organizations agreement to abide by the UW’s Conflict of Interest policy when receiving NASA funded subawards from the UW.
PHS Financial Conflict of Interest Compliance:
The Public Health Service (PHS) regulations state recipients maintain an up-to-date, written, enforced policy on financial conflicts of interest that complies with 42 CFR Part 50 Subpart F and 45 CFR Part 94, and make such policy available via a publicly accessible Web site. This regulation applies to all PHS agencies and certain Non-PHS agencies.
Check the box for YES if the organization has a policy compliant with the PHS regulations and add a link to the policy in the space provided.
Check the box for NO if the organization does not have a policy compliant with the PHS regulations. Checking this box indicates the organization requests that their investigators rely on UW’s FCOI policy when receiving subawards funded by PHS agencies and certain Non-PHS agencies. Use of UW’s FCOI policy requires prior written permission of the UW.
Note: Model PHS-FCOI policies are available on the Federal Demonstration Partnership Conflict of Interest Committee website. The model policy is intended to assist organizations in creating their own Financial Conflict of Interest policy. This model policy has been developed by members of the Federal Demonstration Partnership (FDP) who are familiar with PHS Financial Conflict of Interest requirements; however, organizations are independently responsible for conducting their own review to ensure that this model or an adapted version is compliant with PHS policy.
DOE Financial and Organizational Conflict of Interest Compliance:
The US Department of Energy (DOE) requires each recipient have an up-to-date, written, and enforced administrative process that complies with 2 CFR part 910, Department of Energy (DOE) Financial Assistance Regulations and DOE’s Interim Conflict of Interest Policy.
Check the box for YES if the organization has a policy compliant with 2 CFR part 910, Department of Energy (DOE) Financial Assistance Regulations and the DOE’s Interim Conflict of Interest Policy and add a link to the policy in the space provided.
Check the box for NO if the organization does not have a policy compliant with Department of Energy (DOE) Financial Assistance Regulations 2 CFR part 910, Department of Energy (DOE) Financial Assistance Regulations and the DOE’s Interim Conflict of Interest Policy. Checking this box indicates the organization requests that their investigators rely on UW’s FCOI policy when receiving subawards funded by DOE. Use of UW’s FCOI policy requires prior written permission of the UW.
Debarment Suspension Proposed Debarment:
People and organizations may be debarred from receiving U.S. federal financial and non-financial assistance. Debarment or suspension of a participant in a program by one agency has a U.S. government-wide effect.
Check the YES or NO box in response to the question.
If you check NO, check the boxes “a” through “d” that apply to the organization’s debarment status.
Non-Discrimination and Anti-Bribery Compliance - Domestic Form Only:
Federal regulations in place to prevent unlawful discrimination nor will it discriminate against any person because of race, color, religion, national origin, age, handicap, status as a Vietnam era or disabled veteran, sex, or sexual orientation with respect to their employment, personnel, or patient care policies and practices. The Foreign Corrupt Practices Act of 1977 is a United States federal law that prohibits U.S. citizens and entities from bribing foreign government officials to benefit their business interests.
- Check the box for YES, NO, or N/A to show whether the organization has a written policy of nondiscrimination and a system for complying with U.S. federal civil rights requirements.
- Check the box for YES, NO, or N/A to show whether the organization enters into agreements for work or research to be performed outside of the U.S. and has systems to assure compliance with the Foreign Corrupt Practices Act of 1977 or other applicable anti-bribery laws.
Section B - Audit Status
This section requires the organizations authorized representative to indicate Yes or No on the organization’s audit status.
1. U.S. Federal Funding:
Check the box for YES if the organization received U.S. federal funding directly and/or via a subaward/subcontract in its most recent fiscal year.
Check the box for NO if the organization did not receive U.S. federal funding directly and/or via a subaward/subcontract in its most recent fiscal year.
2. Total U.S. Federal Funding:
Check the box for YES if the organization expended $750,00 or more in US federal funding directly and/or via a subaward/subcontract in its most recent fiscal year.
Check the box for NO if the organization did not expend $750,00 or more in U.S. federal funding directly and/or via a subaward/subcontract in its most recent fiscal year.
3. Uniform Guidance Single Audit:
Organizations that expend $750,000 or more in federal funding during a single fiscal year must have a single or program-specific audit conducted for that year in accordance with the Uniform Guidance, or 2 CFR Part 200, Subpart F. LINK
Check the box for YES if the organization is had an annual audit in accordance with the Uniform Guidance Single Audit requirements completed by an independent auditor and answer #3a before moving on to the Signature line.
3a. If YES, check the box next to the statement that best reflects the organizations current audit status.
Attach a copy of the audit report with this form or provide a link for where the report can be found in the space provided and move to the Authorized Official Representative approval and signature line at the end of the form.
Check the box for NO if the organization did not have an annual audit in accordance with the Uniform Guidance Single Audit requirements completed by an independent auditor and complete Section C.
3b. If NO is checked, check the box next to the statement that best reflects the reason the organization did not have a Single Audit completed and move on to Section C.
4. Other Audit:
If the Organization did not receive US federal funding (question 1 in section B is NO), or it did not expend $750,000 or more in US Federal funding in its most recent fiscal year (question 2 in section B is NO), check the box next to the statement that best reflects the Organizations audit status and complete Section C.
Audit Questionnaire
Select YES or NO to each of the statements for each topic within this section.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
Some of the topics require follow up information or a link to the organizations information about the topic.
1. General Information
Select YES or NO to each of the statements under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
2. Cash Management
Select YES or NO to each of the statements under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
3. Payroll
Select YES or NO to each of the statements under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
Within item 3. b. after indicating YES or NO, include a brief description of your organizations payroll process or provide a link tot he organization’s payroll process.
4. Procurement
Select YES or NO for the statement under this topic.
Selecting YES to indicates you are confirming the statement is true.
For items a., b., and c., select them only if the organization has an effective system for their authorization and approval.
5. Property Management
Select YES or NO to each of the statements under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
Within item 5. d. after indicating YES or NO, include a brief description of your organization’s policy on capitalization, depreciation and overall management of capital assets.
6. Cost Transfer
Select YES or NO for the statement under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
Also include a brief description or a link to the your organization’s cost transfer process.
6. Cost Sharing
Select YES or NO for the statement under this topic.
Selecting YES to indicates you are confirming the statement is true.
Selecting NO indicates you are confirming the statement is not true.
Also include a brief description or a link to the your organization’s cost sharing process.
Organization’s Authorized Official Representative Approval & Signature
The Authorized Organizational Representative (AOR) is an individual authorized by an organization to sign and commit the organization to a request, proposal, or other document that has been or is to be submitted to the sponsor while providing the required certifications for this signed document.