Checklist for Assessment of Division/Office Monitoring Plan

OAA Title III C Nutrition Program #93.045 NC Division of Aging and Adult Services Compliance Supplement Criteria Review

Region ______Service Provider______Date ______Reviewer Signature______Service: ( all that apply) Congregate Nutrition  Home Delivered Meals  Nutritional Supplements 

() Compliance Supplement Compliance Supplement Criteria Requirement Determine Compliance in the Following Areas Criteria a. Activities Allowed or Unallowed: Specific activities  Nutrition Monitoring Tool, Part I, Question #2 Yes  No  N/A  identified in the grant agreement, state and federal  Nutrition Monitoring Tool, Part I, Question #13 regulations.  Nutrition Monitoring Tool, Part I, Question #26  Nutrition Monitoring Tool, Part I, Question #27  Nutrition Monitoring Tool, Part III, Question #7 b. Allowable Cost/Cost Principles: Ensure that costs paid  Review DOA-732-A and determine if costs budgeted Yes  No  N/A  are reasonable and necessary for operation and relate to the intended purpose of this fund source. administration of the program. c. Cash Management: *only applies when advances in N/A excess of 60 days are provided to DOA subrecipients. d. Davis-Bacon Act: Not applicable to DHHS. N/A e. Eligibility: Assure that only eligible individuals receive  Nutrition Monitoring Tool, Part III, Question C-14 Yes  No  N/A  services and assistance under this program.  Nutrition Monitoring Tool, Part III, Question C-15 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:  Review ZGA-370 to verify reimbursement and 10% Yes  No  N/A  Specific percentage required which must be provided to required match through the Aging Resource receive funding. Level of Effort and Earmarking are not Management System. required.

09/21/04 #93.045 Title III C Nutrition 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  Verify signature of DOA-732. Yes  No  N/A  period authorized for federal and state funds to be  If applicable, determine if carry forward funding has expended (July – June). been approved on the DOA-732.  Verify the budgeted amounts on the ZGA-370 report series to the DOA-732. i. Procurement, and Suspension and Debarment: Assure  Verify signature of DOA-734 assurances. Yes  No  N/A  that a subrecipient follows policies and procedures for procurement and has not been suspended or debarred by the federal government from receiving funding. j. Program Income: Assure that program income is used  Nutrition Monitoring Tool, Part I, Yes  No  N/A  to expand services. Question #36 - #39 k. Real Property Acquisition and Relocation N/A Assistance: Does not apply to DHHS. l. Reporting: Assurance that funds are being managed  Nutrition Monitoring Tool, Part I, Question #35 Yes  No  N/A  efficiently and effectively to accomplish the program  Nutrition Monitoring Tool, Part II, Question #C-14 objectives. Reporting requirements are contained in  Nutrition Monitoring Tool, Part II, Question #C-15 the laws, regulations, and contract or grant agreement. m. Subrecipient Monitoring: Subrecipient monitoring is  If part or the entire service delivery component was Yes  No  N/A  applicable if part of the service delivery is subcontracted subcontracted with another agency, did with another agency. programmatic monitoring occur? n. Special Tests and Provisions: See annual compliance  Nutrition Monitoring Tool, Part I, Question #C-8 Yes  No  N/A  supplement for special tests and provisions.  Nutrition Monitoring Tool, Part I, Question #22  Nutrition Monitoring Tool, Part II, Question #C-14  Nutrition Monitoring Tool, Part II, Question #C-15 o. Conflict of Interest: For non-profit subrecipients only, a  Subrecipient has a notarized copy of their conflict of Yes  No  N/A  notarized copy of the subrecipient’s policy addressing interest policy on file. conflicts of interest must be seen.

Comment on each compliance criteria that is not met: ______

09/21/04 #93.045 Title III C Nutrition Page 2 of 2 ______

09/21/04 #93.045 Title III C Nutrition Page 2 of 2