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12 <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 4 of 7 <br />C. Reimbursement Reporting: <br />1. Expenditures <br />The Provider will report expenditures monthly in accordance with policy set forth by <br />the Controller's Offices, Division of Social Services, issued via the Fiscal Manual. <br />Expenditures are to be reported on the DSS Administrative Cost Report (Form DSS- <br />1571,Part III). Reports are to be submitted to the Department by the fifth working <br />day of the month following the month in which services were delivered. The <br />Department will reimburse the Provider monthly, usually by check, upon receipt of a <br />completed and correctly filed report. <br />2. Reporting for the Statewide Services Information System (SIS) <br />In addition to the Administrative Cost Report (DSS-1571, Part III), the Provider will <br />submit to the Department the Monthly Report of Service Delivery (DSS Form 1571, <br />Part IV). This should be submitted along with the Administrative Cost Report by the <br />fifth working day of the month following the month in which services were delivered. <br />The units reported in Column 12 of the 1571 Part IV are the units of service defined in <br />Column 5 of LC: of this Attachment. Service definition and reporting instructions are <br />found in Family Services Manual, Volume VI, Chapter IV. <br />D. Audit Requirements <br />The Provider shall be responsible for compliance with the audit requirements of <br />Department of Health and Human Services federal regulation 45 CFR Part 74, <br />Administration of Grants, or State Administrative Procedures Manual for Federal Block <br />Grant Funds, whichever 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 $ 1,000; private, <br />for profit or individual <br />() 2. (Applicable to Private, Non-Profit Providers if reimb. $1,000 or over) <br />An annual audit is to be performed in accordance with OMB Circular A-110 by an <br />"independent auditor." Independent auditor" means either: (a) a state government <br />auditor from the Department of Human Resources or the Department of <br />Administration, Office to the State Auditor; or (b) a certified public accountant. <br />Upon completion of the audit, a copy of the audit report must be forwarded to the <br />county department of social services. <br />