state of connecticut

INTERNAL CONTROL QUESTIONNAIRE
CONFIRMATION OF COMPLETION
 

 

The Internal Control Questionnaire has been completed and reviewed for accuracy. Print this section, have each person sign it and keep on file as your agency's certification of internal control representations.

_____________________________________________________________________________
Name and address of State Agency

_____________________________________________________________________________


Commissioner/Agency Head
 
_______________________________    __________________________    _____________
Name (type or print)  Signature  Date
     


 

Business Manager/Designee
 
_______________________________    _________________________    ______________
Name (type or print)    Signature    Date
     

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