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U.S. Department of the Treasury, Emergency Capital Investment Program: "Form of Process and Controls Certification: Archived Version"

Summary

The Emergency Capital Investment Program form of Supplemental Report Process and Controls Certification, 3-21-2023 Version 1, given on behalf of a Recipient by a duly elected or appointed Senior Executive Officer under Section 4.1(d)(ii) of its Letter Agreement with Treasury. The officer certifies that the processes and controls used to generate the Supplemental Reports for the fiscal year are satisfactory. A Recipient required to include an internal-control attestation with audited financial statements must attach its independent auditor's attestation on those processes and controls. The notice gives OMB Approval No.: 1505-0275, with an expiration date of June 30, 2026.

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Cite this document

“U.S. Department of the Treasury, Emergency Capital Investment Program: ‘Form of Process and Controls Certification: Archived Version.’” Original at home.treasury.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/u-s-department-of-the-treasury-emergency-capital-investment-program-fo-f7f4b9ad2e/, SHA-256 e3d818567154640de28c757ad61e1bebcbbe8680db6f050bf69d2d62c623d736.

Full text

3-21-2023 Version 1


                           Emergency Capital Investment Program

                                    Required Certifications

               FORM OF PROCESS AND CONTROLS CERTIFICATION

   SUPPLEMENTAL REPORT PROCESS AND CONTROLS CERTIFICATION OF
                          [RECIPIENT]

In connection with that certain Letter Agreement, dated [              ], 20[ ] (the “Agreement”)
by and between [RECIPIENT] (the “Recipient”) and the United States Department of the Treasury
(the “Investor”), the undersigned does hereby certify on behalf of the Recipient as follows:

   1. I am a duly elected/appointed Senior Executive Officer of the Recipient.

   2. The processes and controls used to generate the Supplemental Reports for the Recipient’s
      fiscal year ending [          ], 20[ ] are satisfactory.

   3. If the Recipient is required to include an attestation as to its internal control over financial
      reporting in connection with the filing of audited financial statements with any
      Governmental Entity or self-regulatory agency, attached hereto is an attestation with
      respect to the processes and controls used to generate the Supplemental Reports from the
      Recipient’s independent auditor.

   4. The undersigned and the Recipient understand that a knowing and willful false or
      fraudulent statement made in connection with this certification may be punished by fine,
      imprisonment, or both. (See, for example, 18 U.S.C. 1001).

The foregoing certifications are made and delivered as of [                          ] pursuant to
Section 4.1(d)(ii) of the Agreement.

Capitalized terms used and not otherwise defined herein shall have the meanings assigned to them
in the Agreement unless otherwise stated.

                                     [Signature page follows]
3-21-2023 Version 1


IN WITNESS WHEREOF, this Certificate has been duly executed and delivered as of the [           ]
day of [      ], 20[ ].




                                                    [RECIPIENT]


                                                    By:
                                                          Name:
                                                          Title:


Paperwork Reduction Act Notice.

OMB Approval No.: 1505-0275
Expiration Date: June 30, 2026

The information collected will be used for the U.S. Government to process requests for support.
The estimated burden associated with this collection of information is 10 minutes per response.
Comments concerning the accuracy of this burden estimate and suggestions for reducing this
burden should be directed to the Office of Privacy, Transparency and Records, Department of the
Treasury, 1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send the form to
this address. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid control number assigned by OMB.

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TREAS-FORM-OF-PROCESS-AND-CONTROLS-CERTIFICATION.pdf
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e3d818567154640de28c757ad61e1bebcbbe8680db6f050bf69d2d62c623d736
Our copy
TREAS-FORM-OF-PROCESS-AND-CONTROLS-CERTIFICATION.pdf
Original
home.treasury.gov
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