Best Practices for Preparing for the Single (A133) Audit

Health centers that receive and expend more than $750,000 in award funds from all federal sources (not just Section 330 funding), must have an audit in accordance with the provisions of 45 CFR Part 75, Subpart F: Audit Requirements. The following tips may be helpful in preparing for your audit:

1. Work closely with the auditor. The auditing firm chosen by the Board of Directors with recommendations by the health center’s key management team should have experience, not only with non-profit organizations, but with Federally Qualified Health Centers (FQHCs). The auditing firm should provide a checklist of documents that the health center will need in order for the fieldwork and completion of the audit to run smoothly. To conduct a single audit, auditors will review the design and existence of internal controls and make sure they function as intended. The audit team will assess whether the internal controls in place facilitate compliance with the requirements of the awarding entity (not just HRSA).
2. Develop a game plan with your finance department. In most cases, the Chief Financial Officer/Finance Director will lead the audit preparation. Regardless of the size of your FQHC, ensure that the finance/accounting department can gather and collect the documentation prior to the arrival of the audit team. Delegate the collection of documents to the appropriate staff. If documentation is missing, talk with the audit team to come up with a plan to submit the documents.
3. For health centers that have a finance committee of the Board, it is important that this committee provides support to the health center’s finance team to complete the audit. Support may include, but is not limited to, discussion on the status, assistance with auditor discussions, or even moral support. Annual completion of the audit can be a stressful time.
4. Ensure that the Board of Directors is kept up to date on the audit progress. Once the audit is completed, the auditor should present the audit findings to the Board of Directors. The Board of Directors is responsible for the financial oversight of the health center.  Chapter 19, Board Authority, Element C notes that the Board of Directors must monitor the financial status of the health center, which includes reviewing the results of the annual audit and ensuring appropriate follow-up actions are taken.

For more information on the requirements regarding the annual audit, please visit: https://bphc.hrsa.gov/compliance/site-visits/site-visit-protocol/financial-management-accounting-systems