"Checklist for Assessment of Division/Office Monitoring Plan"
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 Page 1 of 2 () 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 Page 2 of 2