S - Grant - Home and Community Care Block Grant for Older Adults

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DOA-735 (revised 2/10) provider receives less than $500,000 in state funds. The Department of Health and Human Services will provide confirmation of federal and state expenditures at the close of the state fiscal year. Information on audit and fiscal reporting requirements can be found at http://www.ncgrants.gov/NCGrants/PublicReportsRegulations.j sp. The following provides a summary of reporting requirements under NCGS 143C-6-22 and 23 and OMB Circular A-133 based upon funding received and expended during the service provider's fiscal year. Annual Expenditures Report Required to AAA Allowable Cost for Reporting • Less than $25,000 in Certification form and State N/A State or Federal funds Grants Compliance Re- porting <$25,000 (item # 11, Activities and Accomplishments does not have to be completed) OR Audited Financial Statements in compliance with GAO/GAS (i.e. Yellow Book) • Greater than $25,000 Certification form and Schedule of N/A and less that $500,000 Grantee Receipts >$25,000 and in State or Federal Funds Schedule of Receipts and Expendi- tures OR Audited Financial Statements in compliance with GAO/GAS (i.e. Yellow Book) • $500,000+ in State funds Audited Financial Statement in May use State funds, but and Federal pass through compliance with GAO/GAS (i.e. not Federal Funds in an amount less than Yellow Book) $500,000 $500,000+ in State funds Audited Financial Statement in May use State and Federal and $500,000+ in Federal compliance with OMB Circular funds pass through funds (i.e. A-133 (i.e. Single Audit) at least $1,000,000) • Less than $500,000 in State Audited Financial Statement in May use Federal funds, funds and $500,000+ in compliance with OMB Circular but not State funds. Federal pass through funds A-133 (i.e. Single Audit) 6 of 10