February 2, 2023

Siswaya; Mohamad Romli; Khoerun Huda; Abdul Basith Marzuki

Perkumpulan Masyarakat untuk Demokrasi (Perekat Demokrasi), Kabupaten Tangerang - Banten
Perum Mustika Tigaraksa Blok D5 No. 2, Desa Pasir Nangka, Kecamatan Tigaraksa, Kabupaten Tangerang

Kabupaten Tangerang, Banten, Indonesia

RE: FHI 360’s Subrecipient Monitoring for Compliance with USAID Foreign Recipient/Subrecipient Audit
Requirements (Perkumpulan Masyarakat untuk Demokrasi (Perekat Demokrasi), Kabupaten
Tangerang - Banten)

Dear Siswaya; Mohamad Romli; Khoerun Huda; Abdul Basith Marzuki,

Your non-US based organization received USAID funds from FHI 360. If your organization spent a combined
total of US$750,000 in all U. S. government federal awards (including but not limited to USAID), as a prime
recipient or subrecipient, during your organization’s most recent fiscal year end; an USAID Foreign
Recipient/Subrecipient audit is required per USAID’s Standard Provisions for Non-US Nongovernmental
Organizations, paragraph M2 of ADS 303mab.

If your organization meets these audit threshold requirements, we suggest that you obtain the current
listing of USAID Mission’s acceptable audit firms from your FHI 360’s project’s finance representative.

If your organization does not meet the audit threshold requirements, it is still necessary to complete the
entire certification document.

Please complete all sections of this document and return all pages to: FHI360subaudits@fhi360.org by
February 16, 2023.

Please gather the following information prior to completing the certification document:
 Your organization’s DUNS Number/Unique Entity ID Number
 Listing of all U. S. Government prime and pass-through awards of the organization’s most recent
fiscal year end. For each note:
o The name of the U. S. Government agency or pass-through entity (e.g., USAID, FHI 360)
o U. S. Government ID Numbers (Example: AID-OAA-A-15-00045, UM1AI068619)
o Amount spent during your organization’s most recent fiscal year end. (Local Currency and US
Dollar Equivalency noting the exchange rate used).

IMPORTANT CHANGES: The U. S. dollar annual spending threshold amount has been updated to include all U. S.
Government (USG) federal funds spent during the foreign recipient’s/subrecipient’s fiscal year, and not just USAID
funds. However, if the audit threshold is met, the audit will be performed of the USAID direct and subrecipient
awarded funds only. Do not include Fixed Price Subcontracts in your USG federal funds total spent calculation , because
they are excluded from the audit requirements.
Annual Audit Threshold Requirements
During your organization’s most recent fiscal year end, did your organization spend and meet the
threshold described below?
 A combined total of US$750,000 or more in all U.S. government federal funds (including but not
limited to USAID), was spent.
 Include all USG federal funds spent, including:
 funds awarded to your organization as a prime recipient.
 funds awarded to your organization as an FHI 360’s subrecipient.
 funds awarded to your organization as another organization’s subrecipient.
 Do include Fixed Amount Awards (FAA) in your USG federal funds total spent calculation. (NEW
2023)
 Do not include Fixed Price Subcontracts in your USG federal funds total spent calculation.

Instructions
¬ With the email open, select “Reply All”.
¬ Scroll down and complete Steps 1, 2 and 3.
¬ Attach your organization’s USAID Foreign Recipient/Subrecipient Audit Report or Engagement Letter, if
applicable.
¬ “Send” the email.
¬ Complete and return by February 16, 2023.
If you have questions or issues in completing this certification, please send an email to
FHI360subaudits@fhi360.org.

Step 1: Enter your organization’s details and U.S. Government award information
Perkumpulan Masyarakat untuk Demokrasi (Perekat Demokrasi), Kabupaten Tangerang - Banten, Perkumpulan Masyarakat untuk Demokrasi
(Perekat Demokrasi), Kabupaten Tangerang - Banten, CSPB US EE/Proj Indonesia 10.840.1VCID, G3E-Global Ed Empl Eng BU

☐ Apr – Mar ☒ Jan – Dec ☐ July – June

Organization’s Fiscal Period
☐ July – July ☐ Oct – Sept Other (specify)
Most Recent Fiscal Year End (FYE) ☒ 2022 ☐ 2023
DUNS Number or Unique Entity ID GZACQ86SQPN7

U.S. Gov’t Award ID FHI 360’s

(Example: SUBAWARD ID U.S. Gov’t amount spent U.S. Gov’t amount spent
AID-OAA-A-15- Number (Example: during your during your organization’s Funder
00045, NP00123, organization’s most most recent FYE
UM1AI068619) SNPL0123) recent FYE US$ Equivalent (US$)
Local Currency (LC) Required Information
AID-OAA-L-16-
00005 PIDN 220196 LC 161,656,000 US$ 10,777.07 FHI 360
LC US$
LC US$
LC US$
LC US$
LC US$
LC US$
TOTALS 161,656,000 US$ 10,777.07
Enter Exchange Rate Used US$ 1 = IDR 15,000
Step 2: Please select option 1A, 1B, 2 or 3

1A. Audit Completed and Attached – N/A

We have undergone our required USAID Foreign Recipient/Subrecipient Audit for our fiscal period
noted above.
☐ We are attaching a copy of our final audit report containing corrective action plans.
☐ We are attaching a copy of our draft audit report. We will send the final report when
received.

1B. Audit required, but report has not been issued – N/A

Check all that apply

☐ a. Our organization meets the requirements for an USAID Foreign Recipient/Subrecipient
Audit for our most recent fiscal year end, but a final report has not been issued.
☐ b. We will/have engage an acceptable audit firm compliant with the baseline criteria
described in section 4 of USAID Financial Audit Guide for Foreign Organizations, ADS
591maa dated August 6, 2021, or later.
☐ c. We have/will provide the scope of work to the auditors as detailed in chapters 5.1 thru
5.10 of the “USAID Financial Audit Guide for Foreign Organizations, ADS 591maa”.
☐ d. We are attaching a copy of the engagement letter.
☐ e. We expect the final audit report by date.

2. No Audit is required –
We are not subject to the USAID Foreign Recipient/Subrecipient Audit for the reason(s) indicated
below.
☒ a. We spent less than US$750,000 in all U.S. government awards as a prime or subrecipient
during our most recent fiscal year end. We excluded fixed price contracts expenditures in
our calculations.
☐ b. We are exempt for other reasons. (Explain below)

3. For-profit organization – N/A

☐ We are registered as a for-profit organization.
Note: FHI 360 may contact your organization in the near future.

Perkumpulan Masyarakat untuk Demokrasi (Perekat Demokrasi), Kabupaten Tangerang - Banten, Perkumpulan Masyarakat untuk Demokrasi
(Perekat Demokrasi), Kabupaten Tangerang - Banten, CSPB US EE/Proj Indonesia 10.840.1VCID, G3E-Global Ed Empl Eng BU

Step 3: Certification
I certify that the U.S. government award information provided, and the option selected above are
accurate for the organization I represent.
Preparer’s Name and Title Khoerun Huda - Director
Email Perekatd2010@gmail.com; huda_gmnu@yahoo.co.id

Head of Finance Name and Title Siswaya – Finance Manager

Email Woyo1269@gmail.com
Date February 14, 2023
Perkumpulan Masyarakat untuk Demokrasi (Perekat Demokrasi), Kabupaten Tangerang - Banten, Perkumpulan Masyarakat untuk
Demokrasi (Perekat Demokrasi), Kabupaten Tangerang - Banten, CSPB US EE/Proj Indonesia 10.840.1VCID, G3E-Global Ed Empl Eng BU
Please fill-in and return all pages of this form. Also submit the requested USAID Audit, if
applicable. Return this form and audit to: FHI360subaudits@fhi360.org by February 16, 2023.

Mr. Mark Wagner, Director

Corporate Finance-Financial Management
FHI 360 359 Blackwell Street| Durham, NC 27701 USA
T 1.919.544.7040 | F 1.919.544.7261 | www.fhi360.org