Excel Sample Sheet 33332 | Form De 2017 State Single Audit Rev 07 26 22

Partial file snippet.

Sheet 1: Form DE-2017

	
	
	
	
	
	
	
	
	
		OPM FORM: DE-2017
		                   Supplement to Audit Report
		Office of Policy and Management (OPM)
		

	
	
		(rev. 7/26/22)
		

		Detail of Grant Expenditures paid for with OPM Administered Grants
		

		

		

		

		

	
	
		●OPM will use the information you report on this form to reconcile the information reported on your State Single Audit (SSA) Schedule of Expenditures (SE) with OPM's records.  
		

		

		

		

		

		

		

	
	
		●Only report grant expenditures related to grants awarded and administered by OPM.  Do NOT include information regarding grants awarded or administered by other agencies.
		

	
	
		●REMINDER!  For both this form and the State Single Audit Schedule of Expenditures, you should only report expenditures incurred during the fiscal year of the audit. If, however, you
		

	
	
		did report expenditures on the State Single Audit Schedule of Expenditures which were incurred in a fiscal year(s) other than the fiscal year of the audit report, please provide that 
		

	
	
		information by using separate rows below to report expenditures for each fiscal year.
		

	
	
		●Notes have been provided at the end of this form to provide additional clarification.  Please take the time to read them.
		

		

		

		

		

		

		

	
	
		●This form must be submitted within 90 days from the grantee’s fiscal year end. 
		

	
	
		●IF YOU HAVE QUESTIONS ABOUT HOW TO COMPLETE THIS FORM, CONTACT CRYSTAL HUNTER at 860-418-6208 or via email at Crystal.Hunter@ct.gov.
		

		

		

		

		

		

		

	
	
		SUBMIT THIS FORM VIA REGULAR MAIL TO: Office of Policy and Management, Attn: Crystal Hunter MS# 52ADM, 450 Capitol Avenue, Hartford, CT  06106
		

	
	
		OR SUBMIT THIS FORM VIA EMAIL, in Excel format. Emailed submissions should come directly from the Chief Financial Officer. Email submissions should be sent to Crystal.Hunter@ct.gov
		

	
	
		

		

		

		

		

		

		

		

	
	
		Name of Organization:
		

		Fiscal Year Ended:
		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		This form must be completed and signed by the Chief Financial/Fiscal Officer (CFO) of the organization.  Such signature will serve as certification that the information provided in this report is accurate based upon the underlying financial records maintained by the organization. For electronic submissions, the typed name of the CFO entered in the signature block signifies the signer's certification as stated above. 
		

	
	
		

		

		

		

		

		

		

		

	
	
		Chief Financial Officer Name:
		 
		

		

		

		

		

	
	
		Chief Financial Officer Signature:
		 
		Phone #:
		 
		

		

		

	
	
		Date:
		 
		

		Email:
		 
		

		

	
	
		

		

		

		

		

		

		

		

	
	
		Part I: Expenditures Reported on the Schedule of Expenditures of State Financial Assistance from OPM in the State Single Audit 
		

	
	
		

		

		

		

		

		

		

		

	
	
		Complete the following for all OPM grant programs reported on the Schedule of Expenditures of State Financial Assistance in the State Single Audit except for those programs listed on the EXCLUDE tab below.
		

	
	
		

		

		

		

		

		

		

		

	
	
		Grant Program Name
		Core-CT Number                  (see Note 1) 
		OPM Assigned Grant Award/Project Number
		Amount of Grantee Expenditure*                 (see Note 2)
		Fiscal Year Expenditure Incurred* by Grantee                      (see Note 3)
		Amount Reimbursed to Grantee by OPM         (see Note 4)
		Date (MM/YY) OPM Reimbursed Grantee or NA if not reimbursed
		

	
	
		 
		 
		 
		 
		 
		 
		 
		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		Continuation of Part I: Expenditures Reported on the Schedule of Expenditures of State Financial Assistance from OPM in the State Single Audit                                     
		 (FORM DE-2017)
		

	
	
		Grant Program Name
		Core-CT Number                  (see Note 1) 
		OPM Assigned Grant Award/Project Number
		Amount of Grantee Expenditure*                 (see Note 2)
		Fiscal Year Expenditure Incurred* by Grantee                      (see Note 3)
		Amount Reimbursed to Grantee by OPM         (see Note 4)
		Date (MM/YY) OPM Reimbursed Grantee or NA if not reimbursed
		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

	
	
		Part II: Additional Information for Expenditures of State Financial Assistance from OPM related to Advance Payments
		

	
	
		Complete the following if you have received and not fully expended ADVANCE funds from OPM. Advance funds expended in the fiscal year of the audit should be reported in Part I. 
		

	
	
		Grant Program Name
		Core-CT Number         (see Note 1)  
		OPM Assigned Grant Award/Project Number
		Amount of Advance Payment from OPM 
		Date (MM/YY) of Advance Payment from OPM
		Cumulative Amount of Advance Payment Expended as of End of Audit Period          
		Balance of Advance OPM Payment
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		 
	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		

		

		

		

		

		

		$0.00
		

	
	
		Note 1:  The Core-CT number is usually an eighteen digit code representing the fund, state department and special identification number (SID) for the grant program. These numbers can be found at the bottom of your Notice of Grant Award or in the State Single Audit Compliance Supplement** under the Grant Program Name.  If you cannot find a Core-CT number, please contact Crystal.Hunter@ct.gov or call her at 860-418-6208.
		

	
	
		Note 2:  The total of expenditures for each grant program listed in Part 1 of this report should match the total for the grant program listed on the State Single Audit Schedule of Expenditures of State Financial Assistance. 
		

	
	
		Note 3:  "Incurred" is defined as the actual date on which the goods and/or services were physically received (regardless of when paid).
		

	
	
		Note 4: Use separate rows if reporting more than one reimbursement.
		

		

		

		

		

		

		

	
	
		*An "expenditure" is recognized ("incurred") on the actual date the goods and/or services were physically received (regardless of when paid).
		

	
	
		**click this link to be directed to the State Single Audit Compliance Manual
		

	



Sheet 2: EXCLUDE these grants on DE-2017

	
	
	
	
	
	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		DO NOT INCLUDE EXPENDITURES ASSOCIATED WITH THE FOLLOWING GRANT PROGRAMS ON FORM DE-2017
		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Mashantucket Pequot and Mohegan Fund Grant
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Muncipal Grants in Aid
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Muncipal Restructuring
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Municipal Revenue Sharing
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Municipal Stabilization
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Municipal Transition
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Payment in Lieu of Taxes (PILOT) on Exempt Property of Manufacturing Facilities in Distressed Municipalities
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Property Tax Relief for Elderly Homeowners - Freeze Program
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Property Tax Relief for Veterans
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Property Tax Relief on Property of Totally Disabled Persons
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		Tiered Payment in Lieu of Taxes (PILOT)
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		rev. 7/26/22

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...Sheet form de opm supplement to audit report office of policy and management rev detail grant expenditures paid for with administered grants will use the information you on this reconcile reported your state single ssa schedule se s records only related awarded by do not include regarding or other agencies reminder both should incurred during fiscal year if however did which were in a than please provide that using separate rows below each notes have been provided at end additional clarification take time read them must be submitted within days from grantee rsquo questions about how complete contact crystal hunter via email crystalhunter ctgov submit regular mail attn ms adm capitol avenue hartford ct excel format emailed submissions come directly chief financial officer sent name organization ended completed signed financialfiscal cfo such signature serve as certification is accurate based upon underlying maintained electronic typed entered block signifies signer stated above phone da...

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OPM FORM: DE-2017	Supplement to Audit Report				Office of Policy and Management (OPM)
(rev. 7/26/22)		Detail of Grant Expenditures paid for with OPM Administered Grants
●OPM will use the information you report on this form to reconcile the information reported on your State Single Audit (SSA) Schedule of Expenditures (SE) with OPM's records.
●Only report grant expenditures related to grants awarded and administered by OPM. Do NOT include information regarding grants awarded or administered by other agencies.
●REMINDER! For both this form and the State Single Audit Schedule of Expenditures, you should only report expenditures incurred during the fiscal year of the audit. If, however, you
did report expenditures on the State Single Audit Schedule of Expenditures which were incurred in a fiscal year(s) other than the fiscal year of the audit report, please provide that
information by using separate rows below to report expenditures for each fiscal year.
●Notes have been provided at the end of this form to provide additional clarification. Please take the time to read them.
●This form must be submitted within 90 days from the grantee’s fiscal year end.
●IF YOU HAVE QUESTIONS ABOUT HOW TO COMPLETE THIS FORM, CONTACT CRYSTAL HUNTER at 860-418-6208 or via email at Crystal.Hunter@ct.gov.
SUBMIT THIS FORM VIA REGULAR MAIL TO: Office of Policy and Management, Attn: Crystal Hunter MS# 52ADM, 450 Capitol Avenue, Hartford, CT 06106
OR SUBMIT THIS FORM VIA EMAIL, in Excel format. Emailed submissions should come directly from the Chief Financial Officer. Email submissions should be sent to Crystal.Hunter@ct.gov

Name of Organization:			Fiscal Year Ended:

This form must be completed and signed by the Chief Financial/Fiscal Officer (CFO) of the organization. Such signature will serve as certification that the information provided in this report is accurate based upon the underlying financial records maintained by the organization. For electronic submissions, the typed name of the CFO entered in the signature block signifies the signer's certification as stated above.

Chief Financial Officer Name:
Chief Financial Officer Signature:			Phone #:
Date:			Email:

Part I: Expenditures Reported on the Schedule of Expenditures of State Financial Assistance from OPM in the State Single Audit

Complete the following for all OPM grant programs reported on the Schedule of Expenditures of State Financial Assistance in the State Single Audit except for those programs listed on the EXCLUDE tab below.

Grant Program Name	Core-CT Number (see Note 1)	OPM Assigned Grant Award/Project Number	Amount of Grantee Expenditure* (see Note 2)	Fiscal Year Expenditure Incurred* by Grantee (see Note 3)	Amount Reimbursed to Grantee by OPM (see Note 4)	Date (MM/YY) OPM Reimbursed Grantee or NA if not reimbursed






Continuation of Part I: Expenditures Reported on the Schedule of Expenditures of State Financial Assistance from OPM in the State Single Audit						(FORM DE-2017)
Grant Program Name	Core-CT Number (see Note 1)	OPM Assigned Grant Award/Project Number	Amount of Grantee Expenditure* (see Note 2)	Fiscal Year Expenditure Incurred* by Grantee (see Note 3)	Amount Reimbursed to Grantee by OPM (see Note 4)	Date (MM/YY) OPM Reimbursed Grantee or NA if not reimbursed









Part II: Additional Information for Expenditures of State Financial Assistance from OPM related to Advance Payments
Complete the following if you have received and not fully expended ADVANCE funds from OPM. Advance funds expended in the fiscal year of the audit should be reported in Part I.
Grant Program Name	Core-CT Number (see Note 1)	OPM Assigned Grant Award/Project Number	Amount of Advance Payment from OPM	Date (MM/YY) of Advance Payment from OPM	Cumulative Amount of Advance Payment Expended as of End of Audit Period	Balance of Advance OPM Payment
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
						$0.00
Note 1: The Core-CT number is usually an eighteen digit code representing the fund, state department and special identification number (SID) for the grant program. These numbers can be found at the bottom of your Notice of Grant Award or in the State Single Audit Compliance Supplement** under the Grant Program Name. If you cannot find a Core-CT number, please contact Crystal.Hunter@ct.gov or call her at 860-418-6208.
Note 2: The total of expenditures for each grant program listed in Part 1 of this report should match the total for the grant program listed on the State Single Audit Schedule of Expenditures of State Financial Assistance.
Note 3: "Incurred" is defined as the actual date on which the goods and/or services were physically received (regardless of when paid).
Note 4: Use separate rows if reporting more than one reimbursement.
*An "expenditure" is recognized ("incurred") on the actual date the goods and/or services were physically received (regardless of when paid).
**click this link to be directed to the State Single Audit Compliance Manual

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