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Single Audit Page 1
Data Collection Form for Reporting on
AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS
RETURN TO: Federal Audit Clearinghouse, 1201 E. 10th Street, Jeffersonville, IN 47132
Form SF-SAC(3-20-2001) OMB #0348-0057
EIN : 930903782
Part I: GENERAL INFORMATION
1.
Fiscal year ending date for this submission (mm/dd/
yyyy)
12/31/2001
2.
Type
of A-133
audit
Single
audit
3.
Audit period covered
Annual
CENSUS
USE
ONLY
4.
Date received by clearinghouse
5.
Employer Identification Number (EIN)
a.
Auditee EIN
930903782
b.
Are multiple EINS covered in this report?
No
6.
AUDITEE INFORMATION
7.
AUDITOR INFORMATION
a.
Auditee name
CONFEDERATED TRIBES OF COOS,
LOWER UMPQUA AND SIUSLAW INDIANS
b.
Auditee address
(Number and street)
1245 FULTON AVE.
City
COOS BAY
State
OR
Zip Code
97420 -
c.
Auditee contact
Name
CAROL L. BARNES
Title
ACCOUNTING MANAGER
d.
Auditee contact telephone
( 541 ) 888 - 9577
e.
Auditee contact FAX
(Optional)
( 541 ) 888 - 3954
f.
Auditee contact E-mail
(Optional)
CBARNES@CSB.PORTLAND.IHS.GOV
a.
Auditor name
ISLER & CO. L.L.C.
b.
Auditor address
(Number and street)
1976 GARDEN AVE.
City
EUGENE
State
OR
Zip Code
97403 - 1933
c.
Auditor contact
Name
PATTY BOYNTON
Title
CPA
d.
Auditor contact telephone
( 541 ) 342 - 5161
e.
Auditor contact FAX
(Optional)
( 541 ) 342 - 3533
f.
Auditor contact E-mail
(Optional)
PBOYNTON@ISLER-EUGENE.COM
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g.AUDITEE CERTIFICATION STATEMENT -
This 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.
Signature of certifying official
Date
Name/Title of certifying official
CAROL L. BARNES, ACCOUNTING
MANAGER
11/22/2002
g.AUDITOR STATEMENT -
The data elements and
information included in this form are limited to those
prescribed by OMB Circular A-133.The information
included in Parts II and III of the form, except for Part
III, Items 8, 9, and 10, 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.
Signature of certifying official
Date
11/13/2002
FAC DETERMINED TYPE OF ENTITY:
Indian Tribe-Wide/Alaskan Native Village-Wide
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Single Audit Page 3
Form SF-SAC(3-20-2001)
OMB #0348-0057
EIN : 930903782
Part III: FEDERAL PROGRAMS Continued
10.
FEDERAL AWARDS EXPENDED DURING FISCAL YEAR
11.
AUDIT FINDINGS
Row
10a. CFDA Number
Federal
Agency
Prefix (1)
Extension
(2)
10b. Research
and
development
10c. Name of Federal
Program
10d. Amount
expended
in Whole Numbers
10e.
Direct
Award
10f.
Major
program
11a. Type of
compliance
requirement
(3)
11b. Audit
finding
reference #
(s) (4)
1
15.021
N
BUREAU OF INDAIN
AFFAIRS - INDIAN
SELF
DETERMINATION
AGREEMENT
$ 1,080,833
Y
Y
O
N/A
2
15.020
N
BUREAU OF INDAIN
AFFAIRS - AID TO
TRIBAL
GOVERNMENTS
$ 14,626
Y
N
O
N/A
3
15.033
N
BUREAU OF INDIAN
AFFAIRS-ROAD
MAINTENANCE
INDIAN PROGRAMS
$ 184,842
Y
N
O
N/A
4
15.904
N
NATIONAL PARK
SERVICE - HISTORIC
PRESERVATION
$ 395
Y
N
O
N/A
5
93.575
N
DEPARTMENT OF
HEALTH AND
HUMAN SERVICES -
CHILD CARE AND
DEVELOPMENT
$ 64,576
Y
N
O
N/A
6
93.047
N
DEPARTMENT OF
HEALTH AND
HUMAN SERVICES -
ADMINISTRATION
AGING TITLE VI
$ 50,295
Y
N
O
N/A
7
93.612
N
DEPARTMENT OF
HEALTH AND
HUMAN SERVICES -
AMERICAN NATIVE
ASSOCIATION
$ 210,914
Y
N
O
N/A
8
93.667
N
PASS THROUGH
STATE OF OREGON -
CHILDREN SERVICES
BLOCK GRANTS
$ 19,756
N
N
O
N/A
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9
93.556
N
PASS THROUGH
STATE OF OREGON -
FAMILY
PRESERVATION
$ 5,715
N
N
O
N/A
10
93.194
N
PASS THROUGH
STATE OF OREGON -
ALCOHOL AND DRUG
ABUSE PROGRAM
$ 53,244
N
N
O
N/A
11
93.919
N
PASS THROUGH
STATE OF OREGON -
BREAST AND
CERVICAL CANCER
PROGRAM
$ 571
N
N
O
N/A
12
93.228
N
INDIAN HEALTH
SERVICE - INDIAN
SELF
DETERMINATION
AGREEMENT
$ 1,895,450
Y
Y
B
2001-1
13
93.237
N
INDIAN HEALTH
SERVICE - SPECIAL
DIABETES PROGRAM
FOR INDIANS
$ 9,667
Y
N
O
N/A
14
10.670
N
DEPARTMENT OF
AGRICULTURE -
CULTURAL
SERVICES GRANT
$ 73,196
Y
N
O
N/A
15
84.163A
N
DEPARTMENT OF
EDUCATION -
LIBRARY GRANT
$ 6,142
Y
N
O
N/A
16
81.042
N
DEPARTMENT OF
ENERGY - HOMES
WEATHERIZATION
GRANT
$ 52,729
Y
N
O
N/A
17
66.926
N
DEPARTMENT OF
ENVIRONMENTAL
PROCTECTION
AGENCY
$ 136,474
Y
N
O
N/A
18
16.731
N
DEPARTMENT OF
JUSTICE - TRIBAL
YOUTH PROGRAM
$ 1,965
Y
N
O
N/A
19
16.548
N
DEPARTMENT OF
JUSTICE - JUVENILE
JUSTICE
$ 3,705
Y
N
O
N/A
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20
14.867
N
DEPARTMENT OF
HOUSING AND
URBAN
DEVELOPMENT -
INDIAN HOUSING
BLOCK GRANT
$ 742,932
Y
Y
O
N/A
21
14.862
N
DEPARTMENT OF
HOUSING AND
URBAN
DEVELOPMENT
$ 17,089
Y
N
O
N/A
Computer Generated Total Federal
Awards Expended:
$ 4625116
TOTAL FEDERAL AWARDS EXPENDED
$4625116
*Footnotes for Part 3 - Item 10 and Item 11
1. See Appendix 1 of instructions for valid Federal Agency two-digit prefixes.
2. Or other identifying number when the Catalog of Federal Domestic Assistance (CFDA) number is not available.
3. Enter the letter(s) of all type(s) of compliance requirement(s) that apply to audit findings (i.e., noncompliance,
reportable conditions (including material weakness), questioned costs, fraud, and other items reported under §_.510(a))
reported for each Federal program.
A. Activities allowed or unallowed
B. Allowable costs/cost principles
C. Cash management
D. Davis-Bacon Act
E. Eligibility
F. Equipment and real property
management
G. Matching, level of effort,
earmarking
H. Period of availability of funds
I.
Procurement and suspension and
debarment
J.
Program income
K. Real property acquisition and
relocation assistance
L. Reporting
M. Subrecipient monitoring
N. Special tests and provisions
O. None
P. Other
4. N/A for None.
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