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State of North Carolina <br />Division of Social Services <br />Contract Application Page 4 of 8 <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 />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 />