Checklist for Assessment of Division/Office Monitoring Plan

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					                                         Title IIID Disease Prevention Health Promotion #93.043
                      NC Division of Aging and Adult Services Compliance Supplement Criteria Review

Region _________________________________ AAA or Service Provider__________________________________
Date ____________________ Reviewer Signature______________________________________________
Service: ( all that apply): Health Promotion  Health Screening 
                                                                                                                       () Compliance Supplement
          Compliance Supplement Criteria Requirement                  Determine Compliance in the Following Areas              Criteria
a. Activities Allowed or Unallowed: Specific activities            Monitoring Tool for Entities Receiving Title      Yes     No         N/A 
   identified in the grant agreement, state and federal             III-D Funds Question #1
   regulations.                                                   Monitoring Tool for Entities Receiving Title
                                                                    III-D Funds Question #3
                                                                  Monitoring Tool for Entities Receiving Title
                                                                    III-D Funds Question #4
                                                                  Monitoring Tool for Entities Receiving Title
                                                                    III-D Funds Question #7 a & b
b. Allowable Cost/Cost Principles: Ensure that costs paid         Review documentation that supports all             Yes     No         N/A 
   are reasonable and necessary for operation and                   requests for reimbursement and determine if
   administration of the program.                                   costs are reasonable and appropriate for Health
                                                                    Promotion Disease Prevention
                                                                    activities/services.
c. Cash Management: *only applies when an advance in             N/A
   excess of 60 days is provided to a DOA subrecipient.
d. Davis-Bacon Act: Not applicable to DHHS.                      N/A
e. Eligibility: Assure that only eligible individuals receive     Determine that services benefit person 60          Yes     No         N/A 
   services and assistance under this program.                      years of age and older.
f. Equipment and Real Property Management: Equipment             N/A
   defined as tangible property with a useful life more than
   one year and a cost of $5,000 or more may only be
   purchased if specifically approved in the contract or grant
   agreement.
g. Matching, Level of Effort, Earmarking: Matching (10%)            Monitoring Tool for Entities Receiving Title     Yes     No         N/A 
   and Earmarking (23.62% for Medication Management                  III-D Funds Question #5
   services) is required. Level of Effort is not required,          Monitoring Tool for Entities Receiving Title
                                                                     III-D Funds Question #7c

                                                                                                                              #93.043Title IIID
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                                                                                                                          () Compliance Supplement
            Compliance Supplement Criteria Requirement                  Determine Compliance in the Following Areas               Criteria
h. Period of Availability of Federal Funds: The time period          Verify signature of the contract stating period     Yes  No          N/A 
   authorized for federal and state funds to be expended (July        of availability.
   – June).                                                         If applicable, determine if carry-forward
                                                                      funding have been approved by DAAS.
i. Procurement, and Suspension and Debarment: Assure                Verify that contract for services is signed and      Yes  No          N/A 
   that a subrecipient have and follow policies and                   references 45 CFR 92.36(b)(11) that states the
   procedures for procurement and that subrecipients have             subrecipient has procedures for settling all
   not been suspended or debarred by the federal government           contractual and administrative issues arising
   from receiving funding.                                            out of procurement of services.
j. Program Income: Assure that program income is used to            Verify that if program income is collected that      Yes  No          N/A 
   expand services.                                                   this information is appropriately reported
                                                                      through the ARMS to expand services.
k. Real Property Acquisition and Relocation Assistance:            N/A
   Does not apply to DHHS.
   Reporting: Assurance that funds are being managed                  Verify that the contracting agency has             Yes  No          N/A 
   efficiently and effectively to accomplish the program               submitted the Title III D Annual Report the
   objectives. Reporting requirements are contained in the             number of unduplicated persons served report
   laws, regulations, and contract or grant agreement.                 by activity to the Area Agency on Aging.

l. Subrecipient Monitoring:                                           If part or the entire service delivery component   Yes  No          N/A 
   Subrecipient monitoring is applicable if part of the service        was subcontracted with another agency, did
   delivery is subcontracted with another agency.                      programmatic monitoring occur?
n. Special Tests and Provisions: See annual compliance                If service is provided by an AAA, determine if     Yes  No          N/A 
   supplement for special tests and provisions.                        direct service waiver has been granted from
                                                                       DOA.
                                                                      Determine that services are not recreational in
                                                                       nature.
     Conflict of Interest: For non-profit subrecipients only, a       Subrecipient has a notarized copy of their         Yes  No          N/A 
     notarized copy of the subrecipient’s policy addressing            conflict of interest policy on file.
     conflicts of interest must be seen.
Comment on each compliance criteria that is not met: ____________________________________________________________________________________________

_____________________________________________________________________________________________________________________________ ____________
 10/5/06                                                                                                                           #93.043Title IIID
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