Appendix 1

EXAMPLES OF MONITORING POLICIES,

FORMS AND DOCUMENTS

Appendix 1 - 1

APPENDIX 1

EXAMPLES OF MONITORING POLICIES, FORMS AND DOCUMENTS

Example 1 - Washington State contract monitoring policy......

Example 2 - Kansas grant monitoring policy......

Example 3 - Iowa on-site monitoring standards

Example 4 -Minnesota checklist

Example 5 - Pennsylvania program service standards......

Example 6 - Kansas checklist of expectations during the on-site review process

Example 7 - Michigan letter, with enclosure, to confirm site visit

Example 8 - Minnesota pre-visit questionnaire sent to subgrantees

Example 9 - Iowa pre-visit form, using a Word template, sent to subgrantees

Example 10 - Pennsylvania checklist used as pre-visit document to be completed as
much as possible by subgrantee.

Example 11 - Washington State information sent to subgrantees explaining on-site
contract monitoring.

Example 12 - Iowa site visit report

Example 13 - Minnesota form used to prepare a narrative of the site visit report.

Example 14 - Michigan computer generated format uses checklists and expandable
narrative to prepare site visit report.

Example 15 - Michigan policy for non-compliance

Example 16 - Washington State letter including corrective action plan

Example 17 - Massachusetts site visit report with corrective action and follow-up

Example 18 - Minnesota sample letter reporting deficiencies and corrective action

Example 19 – Minnesota funding decision appeals policy......

Appendix 1 - 1

Example 1 - Washington State contract monitoring policy

DSHS Children’s Administration

Domestic Violence/Victim Services Program

Contract Monitoring Protocol

  1. Purpose: The purpose of this protocol is to (1) comply with DSHS Administrative Policy 13.11 (General Contract Monitoring Policy) and CA Administrative Policy 01-03 (Contractor Monitoring), and (2) appropriately budget limited staff resources for on-site contract monitoring. The protocol sets forth the criteria used by the Domestic Violence/Victim Services Program (DVVSP) to conduct desk and on-site monitoring of its contractors.
  1. Methods of Contract Monitoring: Contract monitoring is an on-going, often daily process that involves one or more of the following activities on the part of the assigned CA Program Manager:
  1. Annual Contract Application Review and Assurances (Self-Assessment) – Annual Contract Compliance Self-Assessment, Part A – Contractor Profile is completed annually by each contractor as part of the contract renewal or amendment process.
  1. Complaints – Complaints regarding a contracted program are investigated within the parameters of the contract document and/or applicable statute or rule.
  1. Desk Monitoring – Desk monitoring includes a review of invoice submittals and any attachments; backup documentation, if requested by the CA Program Manager; contractor correspondence, telephone calls, and electronic mail submissions; quarterly program summary, match, and financial reports; financial audits (if required); and any other documents or communications that may flow between the CA Program Manager and contractor.
  1. Irregularities or Concerns – Contract monitoring may occur in the context of any identified irregularities or concerns regarding the contracted program, whether the concern is generated internally through desk monitoring, or externally if relevant to the contracted service.
  1. On-site Monitoring – On-site contract monitoring involves regular and periodic review of contractor compliance with contract terms. Monitoring will be scheduled according to the criteria established in items 5. and 6. below.
  1. Types of Contracts to be Monitored: The DVVSP manages the following types of contracts:

a. Client Service

b. Personal Service

  1. Purchased Service
  2. Interlocal (state agency)
  1. Statutory Requirements: Certain statutes or administrative rules govern some, but not all, of the monitoring requirements for contracts managed by the DVVSP.
  1. Federal Victims of Crime Act (VOCA): On-site monitoring of subrecipients is required once every four (4) years.[1] Reviews must include, at a minimum:

(1)Subrecipient policies and procedures that address specific requirements of VOCA and the OJP Financial Guide.

(2)Victim service delivery performance data.

(3)Timekeeping and equipment records.

(4)Documentation for costs supported by VOCA funds.

  1. Domestic Violence Emergency Shelter: WAC 388-61A-0165 requires biennial “evaluation” of contractors to measure compliance with the minimum standards set forth at WAC 388-61A.
  1. Federal Family Violence Prevention and Services Act (FVPSA): There are no specific requirements in the FVPSA Program Guidance.
  1. On-Site Contract Monitoring Schedule: All contracts managed by the DVVSP will be monitored on a regular and daily basis using the methods described in 2.a. – e. above. On-site contract monitoring will be scheduled as follows, but see exceptions to this rule at 6. below:
  1. Client Service Contracts: On-site contract monitoring will be scheduled and conducted once every three (3) years.
  1. Personal Service Contracts: At the discretion of the assigned Program Manager.
  1. Purchased Service and Interlocal (non-client service contracts): At the discretion of the assigned Program Manager.
  1. Exceptions to On-site Contract Monitoring Schedule: The following exceptions to the general on-site contract monitoring schedule will be factored into the annual on-site contract monitoring plan.
  1. New Client Service Contractors – If the contractor has never had a contract with the DVVSP, or it is an agency with whom the DVVSP has not contracted in the previous three (3) years, an on-site contract monitoring visit will be conducted within the first year of the contract start date.
  1. New Type of Service – If the contractor is a current contractor, but the service to be provided is new for the contractor, an on-site contract monitoring visit prior the regularly scheduled visit (see 5. Above) is discretionary on the part of the DVVSP Program Manager.
  1. Issues or Concerns – If there is a significant issue with a current contractor regarding contracted services, an on-site visit distinct from a regularly scheduled visit is discretionary on the part of the DVVSP Program Manager unless the circumstances warrant an on-site review.
  1. Complaints – Where the DVVSP Program Manager is investigating a complaint against a contractor, an on-site visit for investigation purposes will be conducted where circumstances warrant an on-site review.
  1. Annual Contract Monitoring Plan:
  1. In approximately April of each year the DVVSP Program Managers will meet to review and revise, as necessary, the following:

(1)Annual on-site monitoring schedule.[2]

(2)Contract monitoring documents and compliance tools, to include Contract Compliance Assessment/Part B.

(3)Annual contract renewal or contact amendment applications, to include Annual Contract Compliance Self-Assessment/Part A -- Contractor Profile;

  1. By September 15, 2003, the DVVSP Program Managers will meet and prepare the annual contract summary (one (1) summary for DVVSP due 9/30), and annual contract monitoring plan (one (1) plan for DVVSP due 10/31).

Contractor Legal Name
Contractor doing business as (DBA)
Contractor Mailing Address
Area Code/Phone Number / Area Code/Fax Number / Email Address
Contract Type
DV Shelter VOCA Underserved Family Violence Other:
Contract Period of Performance
Contractor Contact Name and Title
Certification
I certify that the information contained in the Contract Compliance Self-Assessment, Part A – Contractor Profile is true and accurate. I acknowledge my obligation to notify the DSHS Program Manager for this contract of any changes to statements made. I understand and agree that by accepting a contract for services with DSHS that I will perform the services as set forth in the contract statement of work and that I will remain in compliance with the contract terms.
______
Signature of Authorized Representative Date Self Assessment Completed
______
Type or Print Name and Title

Instructions: The Annual Contract Compliance Self-Assessment, Part A – Contractor Profile is one of several documents DSHS reviews to gauge contractor compliance with applicable state and federal laws and rules, program guidelines, and the contract. Please review and answer the following questions. The form has been set-up to be easily completed on your computer. If you have any questions, or if you would like to receive this form electronically, contact the Program Manager for your contract. This is not a contract.

Program Administration

  1. Contractor maintains documentation to substantiate its organizational structure and tax status (i.e., Articles of Incorporation, Bylaws, Washington State Business License).

Yes NoExplain if “No”:

  1. Contractor has all insurance coverage required by the contract.

Yes NoExplain if “No”:

  1. For civil rights compliance, the Contractor collects, on at least a quarterly basis, a list of current staff by position (not names) that includes date of birth, gender, and identified protected group status, including race, Vietnam Era Veteran, Disabled Veteran, and person of disability. For protected group data, Contractor must inform staff that furnishing the information is voluntary.

Yes NoExplain if “No”:

  1. Is the Contractor currently, or within the past one (1) year, involved in any litigation or administrative dispute resolution proceeding, including civil rights complaints, by current or past employees or service recipients?

Yes NoExplain if “Yes”:

  1. In the past one (1) year, has the Contractor received any findings or a corrective action plan from any financial audit, license review, administrative proceeding, or contract monitoring review?

Yes NoExplain if “Yes”:

  1. Has the contracted program undergone any major restructuring with the past one (1) year?

Yes NoExplain if “Yes”:

  1. Has there been turnover in the program’s management within the past one (1) year? Management includes executive director, program director, accounting/fiscal staff, etc.

Yes NoExplain if “Yes”:

  1. Has there been turnover of direct services program staff within the past one (1) year? Program staff includes advocates and other direct service staff.

Yes NoExplain if “Yes”:

  1. If the Contractor is required to have and maintain a Board of Directors, what are the minimum and maximum numbers of boardmembers required, in accordance with the agency by-laws.
  1. How many boardmembers are on the agency’s current Board of Directors.
  1. In accordance with the agency by-laws, what constitutes a quorum for the purpose of taking board action.
  1. In the past 12 months, has the board taken any action without having the required quorum present.

Yes NoExplain if “Yes”:

  1. Does the board schedule and conduct meetings on a regular basis and in accordance with agency by-laws.

Yes NoExplain if “No”:

  1. Criminal history background checks (CHBC) are completed on all employees, volunteers, subcontractors, and other persons who may have unsupervised access to children, developmentally disabled persons, or vulnerable adults, prior to these individuals providing services under the contract.

Yes NoExplain if “No”:

  1. Proof of the CHBC is maintained by the contractor.

Yes NoExplain if “No”:

  1. Personnel files are maintained on all staff and volunteers and include at least the following documents: employment application; academic, experience, and employment history; current job description; regular performance evaluations that comply with the agency’s policy on the frequency and process for evaluation; signed, dated statement acknowledging a duty to report child abuse/neglect in accordance with RCW 26.44 (if contractor is a mandated reporter).

Yes NoExplain if “No”:

  1. Contractor maintains written policies/procedures on the following: confidentiality of records and communication; nondiscrimination in services and employment; recruitment, hiring, performance evaluations, promotion and termination of staff/volunteers; job descriptions for all positions including volunteers; reporting of child abuse/neglect as required by law, if contractor is a mandated reporter; service recipient access to their file; grievance procedure for staff and service recipients; protection of agency and service recipient records (both hard copies and electronic); drug-free workplace; accounting procedures; personnel policies.

Yes NoExplain if “No”:

  1. Contractor maintains a fixed assets log that identifies all equipment assets purchased with contracted funds that includes at least the following information: description, serial number, acquisition date, invoice/cost; location; disposition data (date of disposal and sale price).

Yes NoExplain if “No”:

  1. Contractor maintains back-up documentation for contract match reported on the quarterly Program Summary and Match Report submitted to DSHS.

Yes NoExplain if “No”:

  1. Contractor anticipates subcontracting certain services/activities required to be performed by the contract statement of work.

Yes NoExplain if “Yes”:

  1. If contractor anticipates subcontracting for services, contractor will obtain and maintain a written agreement/subcontract between the parties.

Yes No N/A

  1. Contractor provides, or arranges for the provision of, qualified interpreters for all persons provided services pursuant to the DSHS contract, when interpreter services are necessary.

Yes NoExplain if “No”:

  1. Contractor maintains a file for each individual provided services pursuant to the DSHS contract.

Yes NoExplain if “No”:

  1. Service recipient files adequately document eligibility for services and the services provided.

Yes NoExplain if “No”:

  1. Describe how service recipient files, communications, and information are kept confidential and safeguarded (e.g. locked file cabinets, electronic files, archived files, etc.).

Fiscal Administration

1.Contractor’s accounting system identifies the receipt and expenditures of program funds separately for each contract/grant.
Yes NoExplain if “No”:
2.Contractor uses a double-entry system in accounting for funds.
Yes NoExplain if “No”:
3.Contractor maintains time sheets for employees compensated from the DSHS contract. Timesheets are signed in ink by a supervisor.
Yes NoExplain if “No”:
4.Where employees are paid from multiple contracts/grants, explain the method(s) used by the employer to accurately apportion costs among the various fund sources.
5.In the past one (1) year has the contractor had a contract terminated for default, been suspended, or been sanctioned for contract noncompliance.
Yes NoExplain if “Yes”:
6.Contractor understands that no DSHS contract funds can be expended for lobbying activities as described in the contract.
Yes NoExplain if “No”:
7.Contractor expends more than $500,000 annually in federal funds (OMB Circular A-133 threshold amended 6/27/03; effective fiscal years ending 12/31/2003).
Yes No
8.If yes, when was the agency’s most recent A-133 audit completed.
9.Were there any audit findings.

Yes No

10.Was a copy of the A-133 audit and management letter (if any) submitted to the DSHS Program Manager within nine (9) months from the end of the contractor’s fiscal year.

Yes NoExplain if “No”:

  1. Contractor expends more than $100,000 annually in state funds from DSHS but less than $500,000 annually in federal funds.

Yes No

  1. If yes, when was the agency’s most recent independent financial audit completed.

13.Were there any audit findings.

Yes No

14.Was a copy of the independent audit and management letter (if any) submitted to the DSHS Program Manager within nine (9) months from the end of the contractor’s fiscal year.

Yes NoExplain if “No”:

Contract Specific Requirements

ALL CONTRACTORS receiving federal funds must answer the following question:

Contractor agrees that prior to using any federal funds in your contract to renovate, alter, or otherwise improve the exterior or interior of a building, you will establish identification, recordkeeping, reporting, consulting and decision-making processes within your programs or procedures for administering contract funds. Contractor also agrees that proposed renovation work, as it relates to the National Historic Preservation Act (NHPA), includes work not specifically funded with VOCA or FVPSA funds but funded by the Contractor or any third party as a prerequisite to accommodate the proposed use of contract funds. Contractor shall contact the DSHS Program Manager for additional implementation guidance before deciding on any renovation work for which Contractor is unsure of the application of the NHPA.

Yes NoExplain if “No”:

Answer the following questions if the contractor receives federal Victims of Crime (VOCA) funds in its contract.

  1. Contractor uses volunteers in the program funded by this contract.

Yes NoExplain if “No”:

  1. Number of volunteers:
  1. Contractor provides information to, and assists service recipients in applying for crime victim compensation benefits with the Washington State Department of Labor and Industries.

Yes NoExplain if “No”:

Answer the following question if the contractor receives federal Family Violence Prevention and Services Act (FVPSA) funds in its contract.

Contractor prohibits smoking in any portion of any indoor area routinely owned or leased or contracted for by the contractor and used routinely or regularly for the provision of health, day care, education, or library services to children under the age of 18 years.

Yes NoExplain if “No”:

Appendix 1 - 1

Contract Compliance Self-Assessment. Part A.DOC

..Part A.doc

Contractor:

Date:

Monitor:

Services

  1. Describe the services provided by this contract (e.g. crisis intervention, counseling, medical advocacy, legal representation, legal advocacy, court advocacy, etc.).

Describe:

  1. Services provided are consistent with those required by the contract statement of work.

Yes NoExplain if “No”:

  1. Contractor is providing services to the population(s) described in the contract statement of work.

Yes NoExplain if “No”:

  1. Is the contracted program conducting any of the following activities within the scope of the VOCA funded project:

a. crime prevention activities Yes No

b. general criminal justice improvements Yes No

c. witness notification/management Yes No

d. services to perpetrators/offenders Yes No

e. administrative/legislative lobbying Yes No

  1. Describe how crime victims access services provided by the contract.

Describe:

  1. How does contractor ensure that only eligible victims of crime are provided services under this contract.

Describe:

  1. Contractor provides assistance to service recipients in applying for Crime Victim Compensation.

Yes NoExplain if “No”:

  1. Does Contractor make any cash/check payments directly to service recipients or their dependents from contract funds.

Yes NoExplain if “Yes”: