Single Audit Exemption Form - Wa
1
AGR-2207 (R/9/19) Food Assistance PO Box 42560 Olympia WA 98504-2560 [email protected] Food Assistance – Single Audit Exemption Form Please complete this form if your agency is not required to have a single audit of federal programs in accordance with Subpart F- Audit Requirements of 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Agency Information: Agency Name: Mailing Address: Fiscal Year End Date: Agency Representative or Auditor: Title: Phone: Email: Certification: For the fiscal year indicated above, the agency did not receive $750,000 or more in federal funding including the dollar value of federal food received for all federal programs and is not required to have a single audit of federal programs in accordance with Subpart F – Audit Requirements of the Uniform Guidance. Agency Representative or Auditor Signature : This form is due to WSDA within 30 days after the end of your agency’s fiscal year. Please return completed form to: Washington State Department of Agriculture - Food Assistance 1111 Washington St. SE ~ PO Box 42560 ~ Olympia, WA 98504-2560 Email: [email protected]
Transcript of Single Audit Exemption Form - Wa
AGR-2207 (R/9/19)
Food Assistance PO Box 42560
Olympia WA 98504-2560 [email protected]
Food Assistance – Single Audit Exemption Form Please complete this form if your agency is not required to have a single audit of federal programs in accordance with
Subpart F- Audit Requirements of 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance).
Agency Information:
Agency Name:
Mailing Address:
Fiscal Year End Date:
Agency Representative or Auditor:
Title:
Phone:
Email:
Certification: For the fiscal year indicated above, the agency did not receive $750,000 or more in federal funding including the dollar value of federal food received for all federal programs and is not required to have a single audit of federal programs in accordance with Subpart F – Audit Requirements of the Uniform Guidance.
Agency Representative or Auditor Signature :
This form is due to WSDA within 30 days after the end of your agency’s fiscal year.
Please return completed form to: Washington State Department of Agriculture - Food Assistance
1111 Washington St. SE ~ PO Box 42560 ~ Olympia, WA 98504-2560 Email: [email protected]
