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• 23 ' <br /> State of North Carolina <br /> Division :;f Social Services <br /> Contract Application Page 4 of p <br /> C. Reimbursement Reporting: <br /> 1. Expenditures <br /> The Provider will report expenditures monthly in accordance with <br /> policy set forth by the Controller's Office, Division of Social <br /> Services , issued via the Fiscal Manual. Expenditures are to be <br /> reported on the DSS Administrative Costs Report (Form DSS-1571, <br /> Part III) . Reports are to be submitted to the Department by the fifth <br /> working day of the month following the month in which services were <br /> delivered. The Department will reimburse the Provider monthly, <br /> • <br /> usually by check, upon receipt of a completed and correctly filed <br /> report. <br /> 2. Reporting for the Statewide Services Information System (SIS) <br /> In addition to the Administrative Cost Report (DSS-1571, Part III) , <br /> the Provider will submit to the Department the Monthly Report of <br /> Service Delivery (DSS Form 1571, Part IV) . This should be submitted <br /> along with the Administrative Cost Report by the fifth working day of <br /> the month following the month in which services were delivered. The <br /> units reported in Column 12 of the 1571 Part IV are the units of <br /> service defined in Column 5 of I . C. of this Attachment. Service <br /> definition and reporting instructions are found in Family Services <br /> Manual, Volume VI, Chapter IV. <br /> D. Audit Requirements <br /> The Provider shall be responsible for compliance with the audit <br /> requirements of Department of Health and Human Services federal <br /> regulation 45 CFR Part 74, Administration of Grants, or State <br /> Administrative Procedures Manual for Federal Block Grant Funds , whichever <br /> is applicable. These regulations stipulate that an annual audit be <br /> performed for the fiscal year in which contract funds were received. <br /> ( ) 1. NA <br /> Private, non-profit if amount of reimbursement received is under <br /> $1,000; private, for profit or individual <br /> ( ) 2. (Applicable to Private, Non-Profit Providers if reimb. $1,000 <br /> or over) <br /> An annual audit is to be performed in accordance with OMB <br /> Circular A-110 by an "independent auditor." "Independent <br /> auditor" means either: (a) a state government auditor from <br /> the Department of Human Resources or the Department of <br /> Administration, Office of the State Auditor; or (b) a certified <br /> public accountant. Upon completion of the audit, a copy of the <br /> audit report must be forwarded to the county department of <br /> social services . <br /> DSS-1292 (4/87) <br /> Family Services <br />