Subrecipient Single Audit Submission Form

Subrecipient Single Audit Submission Form

Uniform Guidance at 2 CFR 200 requires MSDH to collect and review the results of Single Audits of our subrecipients. Please complete the form below. If you have questions, please contact the Office of Internal Audit, Subrecipient Monitoring Unit at 601-576-7510 or SubgranteeAudit@msdh.ms.gov.

Organization Name*

Employer Identification Number (EIN)*

Unique Entity Identifier (UEI)*

Financial Contact Name*

Financial Contact Email*

Financial Contact Phone Number*

Phone

Most Recently Completed Fiscal Year End*

For the most recently completed year end listed above, was your organization required to comply with the OMB Uniform Guidance at 2 CFR 200 Subpart F - Audit Requriements?*

Yes

No, we are a U.S. federal government agency.

No, we are a U.S domestic entity that is a for-profit organization.

No, we are a U.S domestic entity that did not expend $750,000 (prior to Oct. 1, 2024) or $1,000,000 (after Oct. 1, 2024) in U.S federal funds during the most recently completed fiscal year.

No, we are a non-U.S. based (foreign) entity that did not expend $750,000 (prior to Oct. 1, 2024) or $1,000,000 (after Oct. 1, 2024) in U.S. federal funds during the most recently completed fiscal year.

Single Audit Status*

We have completed our Single Audit for the most recently completed fiscal year end listed above. The report is available for MSDH review.

We have NOT completed our Single Audit for the most recently completed fiscal year end, and the report is not available.

Anticipated Report Date*

We expect the report to be completed and available by this date. We will resubmit this form when the audit report is available.

Single Audit Report Findings*

Did the Single Audit Report identify significant deficiencies, material weaknesses, questioned costs, or findings related to any subgrants from the Mississippi State Department of Health?

Yes

Single Audit Submission*

Select

Link to Single Audit report*

File Upload*

Drag and drop files here or

Name of Person Completing the Form*

Title of Person Completing this Form*

I certify that I am authorized to complete and submit this form to MSDH on behalf of my organization.*

Please initial.

Send me a copy of my responses

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