South Carolina Department of Social Services
INDIRECT COST RATE CERTIFICATION1. Does your agency have a federally approved indirect cost rate? FORMCHECKBOX Yes FORMCHECKBOX No2. If yes, who is the approving federal agency? FORMCHECKBOX Department Of Labor FORMCHECKBOX Department of Health and Human Services FORMCHECKBOX Other If other, document below ______________________________________________________________________________3. What is your Agency’s federally approved indirect cost rate percentage? FORMTEXT ?????%4. If your agency does not have a federally approved indirect cost rate. Document your indirect case rate below and explain how the rate was determined. Indirect cost rate percentage: FORMTEXT ?????%__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________(If the indirect cost rate percentage was determined by an auditing/accounting professional provide a statement from the audit/accounting professional explaining the methodology used.)4. What is your agency’s indirect cost rate base? (Costs indirect rate percentage will be applied against) FORMCHECKBOX Direct Salaries FORMCHECKBOX Direct Salaries + Fringe FORMCHECKBOX All Direct Costs FORMCHECKBOX OtherIf other, describe indirect cost rate base below: ____________________________________________________________________________________________________________________________________________________________5. Are facilities and administration (F&A) costs included in your agency’s indirect calculation? FORMCHECKBOX Yes FORMCHECKBOX No6. Are utilities and space rental included as a part of your agency’s facilities and administration (F&A)costs? FORMCHECKBOX Yes FORMCHECKBOX No_______________________________________________Agency Name________________________________________________Signature of Agency Financial Officer________________________________________________Date ................
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