Corrective Action Plans

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Housing Voucher Cluster-Assistance Listing No. 14.871/14.879/14.EHV Recommendation: We recommend the Authority review their process and internal controls for new tenants to ensure compliance with HUD requirements and their administrative plan. Explanation of disagreement with audit finding: There is...
Housing Voucher Cluster-Assistance Listing No. 14.871/14.879/14.EHV Recommendation: We recommend the Authority review their process and internal controls for new tenants to ensure compliance with HUD requirements and their administrative plan. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Director of Housing will review our process and internal controls for new tenants to ensure compliance with HUD requirements and our administrative plan. Name(s) of the contact person(s) responsible for corrective action: Director of Housing Planned completion date for corrective action plan: December 31 , 2025
The Fulton County District Attorney's Office has maintained compliance with their policy and procedure regarding time and effort management since August 2024. The SAKI grant employees per policy complete activity reports which document their activities on a biweekly basis, reflect time worked, and t...
The Fulton County District Attorney's Office has maintained compliance with their policy and procedure regarding time and effort management since August 2024. The SAKI grant employees per policy complete activity reports which document their activities on a biweekly basis, reflect time worked, and then sign those reports. Those reports are then reviewed and signed by a supervisor with a knowledge of their work. Those reports are maintained and kept in the Fulton County District Attorney's Office.
View Audit 369827 Questioned Costs: $1
Federal agency: U.S. Department of Health and Human Services Federal Award Project Title: Better Family Life’s Relationship, Education, Advancement, and Development for Youth for Life Project Assistance Listing Number: 93.086 Assistance Listing Program Title: Healthy Marriage Promotion and Responsib...
Federal agency: U.S. Department of Health and Human Services Federal Award Project Title: Better Family Life’s Relationship, Education, Advancement, and Development for Youth for Life Project Assistance Listing Number: 93.086 Assistance Listing Program Title: Healthy Marriage Promotion and Responsible Fatherhood Grants Award Period: September 30, 2023 – September 29, 2024 Award Period: September 30, 2024 – September 29, 2025 Federal agency: U.S. Department of Health and Human Services Federal Award Project Title: Better Family Life’s Teen Pregnancy Prevention Education Assistance Listing Number: 93.297 Assistance Listing Program Title: Adolescent Health Programs Award Period: July 1, 2023 – June 30, 2024 Award Period: July 1, 2024 – June 30, 2025 Management response to 2024-002: In response to the auditors’ recommendation, management has addressed this deficiency by assigning appropriate personnel to review and approve all Federal reporting before submission. Additionally, management has implemented specific procedures for review and approval of drawdown requests, which include reviewing the indirect cost rate applied in all drawdown requests.
Corrective Action Plan Provided by Management: Philadelphia Legal Assistance Center, Inc. (PLA) agrees with the finding. In November 2024, PLA hired a Legal Compliance Specialist whose full-time job is to review open and closed cases for compliance mistakes. The Legal Compliance Specialist did not h...
Corrective Action Plan Provided by Management: Philadelphia Legal Assistance Center, Inc. (PLA) agrees with the finding. In November 2024, PLA hired a Legal Compliance Specialist whose full-time job is to review open and closed cases for compliance mistakes. The Legal Compliance Specialist did not have time to review every case closed in 2024. However, the Legal Compliance Specialist has been reviewing cases all year in 2025 and catching issues with missing citizenship attestations, which should reduce the chances of a case being reported to LSC without the documentation required by 45 C.F.R. 1626. In the summer of 2025, we required all case handlers to watch compliance training videos and answer multiple-choice questions to test their knowledge. The videos and questions included content related to 45 C.F.R. 1626. We plan to require staff to complete a similar training process in 2026, which will include additional content related to 45 C.F.R. 1626 compliance.
View Audit 369802 Questioned Costs: $1
Staffing & Structure: A dedicated Patient Financial Counselor (PFC) position was created and filled on November 27, 2023. A second staff member was transitioned into a PFC role on April 7, 2024, to augment the team. Training & Education: A dedicated Patient Financial Counselor (PFC) position was cre...
Staffing & Structure: A dedicated Patient Financial Counselor (PFC) position was created and filled on November 27, 2023. A second staff member was transitioned into a PFC role on April 7, 2024, to augment the team. Training & Education: A dedicated Patient Financial Counselor (PFC) position was created and filled on November 27, 2023. A second staff member was transitioned into a PFC role on April 7, 2024, to augment the team. Process & Technology Improvements: Monthly Audits: Implement ongoing monthly audits of sliding fee applications to proactively identify and address errors. Staff will receive targeted training based on audit findings. System Enhancement: Awaiting implementation of the Epic Patient Financial Module (released August 2024) to enable real-time tracking and improve outreach to eligible patients.
Ref. No. 2024-001: Missing Signatures Recommendation: The Company should consider reevaluating their established procedures and controls currently in place to ensure full compliance with regard to eligibility and proper maintenance of tenant information, including policies for handling missing files...
Ref. No. 2024-001: Missing Signatures Recommendation: The Company should consider reevaluating their established procedures and controls currently in place to ensure full compliance with regard to eligibility and proper maintenance of tenant information, including policies for handling missing files during management transitions to ensure compliance with HUD requirements. Action Taken: The Company will start randomly testing a small sample of tenant files, as part of our quarterly site inspection. Additionally, Kay-Kay Realty, a third-party vendor is already engaged to review tenant move-in and recertification files, but the prior resident manager was selecting the files to review. We will now ask Kay-Kay Realty to randomly select tenant files for their review process. Contact person: Patrick Delaney; (808) 523-5681, ext. 693 Anticipated Completion Date: October 1, 2025
Contact Person Tawnya Taylor, Executive Director Corrective Action Plan The Authority will review its policies and procedures over program compliance requirements and continue to provide occupancy training to staff to prevent future exceptions. Planned Completion Date for CAP December 31, 2025
Contact Person Tawnya Taylor, Executive Director Corrective Action Plan The Authority will review its policies and procedures over program compliance requirements and continue to provide occupancy training to staff to prevent future exceptions. Planned Completion Date for CAP December 31, 2025
Corrective Action Taken or Planned: The Commission will adopt a policy whereby the Executive Director or a designee will review all future reports prior to submission. Contact person(s) responsible for correction action: Kristi Kane, Executive Director Anticipated Completion Date: Immediately
Corrective Action Taken or Planned: The Commission will adopt a policy whereby the Executive Director or a designee will review all future reports prior to submission. Contact person(s) responsible for correction action: Kristi Kane, Executive Director Anticipated Completion Date: Immediately
Beneficiary Reporting - Auditor’s Recommendation: We recommend that a responsible employee review and approve all HOME Program Housing Beneficiary Reports for accuracy prior to their submission to the applicable oversite agency. The review should contain procedures to match the income amounts per th...
Beneficiary Reporting - Auditor’s Recommendation: We recommend that a responsible employee review and approve all HOME Program Housing Beneficiary Reports for accuracy prior to their submission to the applicable oversite agency. The review should contain procedures to match the income amounts per the HOME Program Housing Beneficiary Reports with the specific tenant income certification forms. We recommend that the reviewer document the date of the income certification form for each unit as well as the initials of the reviewer. Action Taken: In order to ensure the accuracy of the HOME Program Housing Beneficiary Reports, the reports are now routed to our director of Low-Income Housing Tax Credit and Compliance, who reviews each report in detail. This review will include adding the documentation of the date of the specific tenant income certification forms that were utilized to verify the proper income amounts are reported and the initials and date of the review. This documentation will be reviewed by a Board Member and then the reports will be sent to either the City of Las Vegas or Clark County, as required. These procedures will be implemented in October 2025.
The Council has implemented procedures to include documentation of approval for all grant-funded expenditures to strengthen internal controls and ensure compliance with federal standards.
The Council has implemented procedures to include documentation of approval for all grant-funded expenditures to strengthen internal controls and ensure compliance with federal standards.
Choice Neighborhood Incentive Grants – Assistance Listing No. 14.889 Recommendation: We recommend that HABC staff review the controls in place to ensure that required FFATA reporting documentation is complete, accurate, and available for audit. Explanation of disagreement with audit finding: There i...
Choice Neighborhood Incentive Grants – Assistance Listing No. 14.889 Recommendation: We recommend that HABC staff review the controls in place to ensure that required FFATA reporting documentation is complete, accurate, and available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Public Law 109-282, known as the Federal Funding Accountability and Transparency Act of 2006 (FFATA), mandates the public disclosure of all entities and organizations receiving federal funds through a single accessible website. Any subcontract exceeding $30,000 must be reported by the prime recipient of federal funds. However, this reporting requirement does not apply to the Housing Authority of Baltimore City (HABC), similar to the Moving to Work (MTW) block grants and their sub-recipient reporting to the Baltimore Regional Housing Partnership (BRHP). Both awards, the Choice Neighborhood Initiative (CNI) grant awards are not available in the dropdown menu for fulfilling this monthly reporting requirement. This issue was noted because HABC could not demonstrate to the auditors that we had made several unsuccessful attempts to meet this requirement. In response, HABC Finance has established a monthly workflow process to regularly check the website to document the attempts. In addition, we are currently awaiting a formal response from the Department of Housing and Urban Development (HUD) regarding the unavailability of these grants for sub-contracting monitoring & reporting on the SAMs website. Name(s) of the contact person(s) responsible for corrective action: Anu Francis, Chief Financial Officer. Planned completion date for corrective action plan: 12/31/2025
Moving to Work Demonstration Program – Assistance Listing No 14.881 Recommendation: We recommend that HABC staff review the controls in place to ensure that required eligibility determination documentation is complete, accurate, and available for audit. Explanation of disagreement with audit finding...
Moving to Work Demonstration Program – Assistance Listing No 14.881 Recommendation: We recommend that HABC staff review the controls in place to ensure that required eligibility determination documentation is complete, accurate, and available for audit. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Housing Choice Voucher Program response: Out of 40 files reviewed, one exception was noted where recertification was not performed in a timely manner. HABC developed a strategy to verify that all existing recertifications are processed on time. The goal is to catch up by January 2026 and maintain timely processing going forward. HABC has updated its recertification tracking system as part of this plan. This includes measures for weekly progress monitoring, tracking upcoming deadlines, and implementing quality control to support the timely processing of recertifications. Housing Operations response: Housing Operations response: Out of 40 files reviewed, there were two exceptions noted: (1) Documentation was not provided to support the rent amount showing on the rent roll; in that instance, the transaction was corrected after the rent roll had been generated, and the rent amount billed was corrected. The resident was not responsible for paying an incorrect rent amount; Exception (#2) and (#3) are related to same file folder: (2) one requested resident file folder was not submitted for testing; and (3) Third party income verification documentation (including the resident’s signed personal declaration) could not be identified; the file folder was not properly scanned into the electronic document management system and select documents were not otherwise maintained. HABC’s Housing Operations Department will require that all transactions have two levels of review/approval to ensure complete and accurate documentation is scanned into the electronic document management system. Name(s) of the contact person(s) responsible for corrective action: Stefanie Beale, Senior Manager, Continued Assistance & Site Based (HCVP), and Rhonda VanDyke, Senior Manager of Public Housing Administration (LIPH). Planned completion date for corrective action plan: 01/31/2026 for HCVP and 12/31/2025 for LIPH
View Audit 369754 Questioned Costs: $1
Finding 2024 002 – Activities Allowed or Unallowed and Allowable Costs/ Cost Principles, and Procurement Federal Agency: U.S. Department of Transportation Program Name (ALN): Public Transportation Emergency Relief Program (ALN 20.527) Federal Grant Numbers: NJ 44 X004 02 (Federal fiscal years 2012–2...
Finding 2024 002 – Activities Allowed or Unallowed and Allowable Costs/ Cost Principles, and Procurement Federal Agency: U.S. Department of Transportation Program Name (ALN): Public Transportation Emergency Relief Program (ALN 20.527) Federal Grant Numbers: NJ 44 X004 02 (Federal fiscal years 2012–2025) Contact Person: Fatima Castellanos, PATH, Finance & Business Planning Manager, 201-216-6459. Corrective Action: Although federal funds were not received for this expenditure, PATH acknowledges an internal control deficiency regarding the recognition of grant funding for work performed under standard nonfederal engineering call-in contracts. PATH will continue to work collaboratively with the Engineering and Procurement Departments to strengthen internal communications and reinforce adherence to established protocols governing capital projects that are eligible for federal funding. Procurement will provide and document targeted procurement training for awareness to Engineering and PATH staff on adhering to procurement protocols during the execution of contract work that is anticipated to receive federal funding. Anticipated Completion Date: Changes to the controls and processes will be implemented and training provided in the fourth quarter of 2025.
View Audit 369749 Questioned Costs: $1
Eligibility Housing Choice Voucher Cluster - Assistance Listing No. 14.874 Recommendation: We recommend that the Authority review its quality control processes to ensure compliance with HUD rules and regulations. Also, we recommend that the Authority hold training for those involved in the eligibili...
Eligibility Housing Choice Voucher Cluster - Assistance Listing No. 14.874 Recommendation: We recommend that the Authority review its quality control processes to ensure compliance with HUD rules and regulations. Also, we recommend that the Authority hold training for those involved in the eligibility process to ensure that the income and expenses reported on the HUD-50058 is supported with proper calculations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: MHA has designated the Lead Housing Specialist to sample audit files throughout the year. MHA has is also updating its file audit/file order check lists for each employee to double check at recert and interims. Finally, more training will be instituted for newer employees moving forward and bi-weekly staff meetings will occur to review calculation processing. Name(s) of the contact person(s) responsible for corrective action: Ms. Christy Scott and Ms. Tunka Shinholster. Planned completion date for corrective action plan: The above items will be in place and on-going beginning September 30, 2025.
View Audit 369740 Questioned Costs: $1
HQS Enforcement and Annual HQS Inspections Housing Choice Voucher Cluster - Assistance Listing No. 14.874 Recommendation: We recommend management should designate one person to review a sample of the files that have been recertified each month, to determine if the tenant files were prepared in accor...
HQS Enforcement and Annual HQS Inspections Housing Choice Voucher Cluster - Assistance Listing No. 14.874 Recommendation: We recommend management should designate one person to review a sample of the files that have been recertified each month, to determine if the tenant files were prepared in accordance with internal policies and until the compliance deficiencies have been corrected. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: MHA has designated the Lead Housing Specialist to sample audit files throughout the year. MHA is also updating its fileaudit/file order check lists for each employee to double check at recert and interims. Finally, more training wilt be instituted for newer employees moving forward andbi-weekly meetings will occur to review failed inspections to ensure that appropriate abatements or approved extensions have been applied. Name(s) of the contact person(s) responsible for corrective action: Ms. Christy Scott and Ms. Tunka Shinholster. Planned completion date for corrective action plan: The above items wilt be in place and on-going beginning September 30, 2025.
View Audit 369740 Questioned Costs: $1
Finding # 2025-002 Type: Immaterial noncompliance U.S. Department of Commerce, National Oceanic and Atmospheric Administration Assistance Listing #11.441 Finding: Per Uniform Grant Guidance 200.430, charges to federal awards for salaries and wages must be based on actual work performed, supported by...
Finding # 2025-002 Type: Immaterial noncompliance U.S. Department of Commerce, National Oceanic and Atmospheric Administration Assistance Listing #11.441 Finding: Per Uniform Grant Guidance 200.430, charges to federal awards for salaries and wages must be based on actual work performed, supported by internal controls, and part of the official records of the organization. Payroll costs charged to grants are based on estimated allocations not actual hours. All timesheets should include allocated hours by grant before certification by the employee and review by a supervisor. Corrective Action: Time sheet tracking will be modified to track hours by grant so that time and effort reporting will support amount charged to the grant. Anticipated Completion Date December 2025
Re: Federal Awards Audit Finding - 2024-001 Improve Compliance with American Rescue Plan Reporting The Town agrees that expenditures were overstated on the Project and Expenditures Report for American Rescue Plan funds for the period ended March 31, 2024. Furthermore, the town acknowledges that effe...
Re: Federal Awards Audit Finding - 2024-001 Improve Compliance with American Rescue Plan Reporting The Town agrees that expenditures were overstated on the Project and Expenditures Report for American Rescue Plan funds for the period ended March 31, 2024. Furthermore, the town acknowledges that effective internal controls over federal reporting could have prevented this error. Corrective Action Plan The Town will establish and maintain effective internal control over compliance with federal requirements that have a direct and material effect on a federal program. To accomplish this, the Town will implement the practice of dual control for federal grant expenditure reporting. One individual will prepare the expenditure report, while a separate, knowledgeable individual will review the report before it is submitted. To correct the overage reported on March 31, 2024, the Town accurately reported the year-to-date expenditures on the March 31, 2025 Project and Expenditures Report, per federal guidelines. In the future, the preparer of these reports will take more care to understand the compliance requirements of the Federal awarding agency. Name of Contact and Completion Date Matt Mannino Finance Director 603-792-1313 mmannino@bedfordnh.org Anticipated Completion Date: October 31, 2025
Reporting Services for Victims of Human Trafficking – Assistance Listing No. 16.320 Recommendation: We recommend the Organization design controls to ensure reports are prepared and reviewed by separate individuals and that the information gathered to prepare the report is retained. Explanation of di...
Reporting Services for Victims of Human Trafficking – Assistance Listing No. 16.320 Recommendation: We recommend the Organization design controls to ensure reports are prepared and reviewed by separate individuals and that the information gathered to prepare the report is retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: The Organization has implemented a formal review process, as outlined in the board-approved Financial Management Policy & Procedure Manual, to ensure reports are prepared and reviewed by separate individuals before submission to the Federal Agency, and all supporting documentation is retained in accordance with the policy. This process is in practice as of the date of this letter, with corrective actions continuing as needed to ensure effectiveness. Name of the contact person responsible for corrective action: Megan Mattimoe, Executive Director Planned completion date for corrective action plan: December 31, 2025
U.S. Department of Housing and Urban Development 2024-004 Community Development Block Grants – Assistance Listing No. 14.218 Recommendation: We recommend that the County develop internal controls and procedures to ensure that FFATA reporting requirements are met and ensure that all required subaward...
U.S. Department of Housing and Urban Development 2024-004 Community Development Block Grants – Assistance Listing No. 14.218 Recommendation: We recommend that the County develop internal controls and procedures to ensure that FFATA reporting requirements are met and ensure that all required subawards are reported accurately and timely to FSRS or SAM.gov. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: All of our 2024 grants have been entered into FFATA and our 2025 grants and going forward will be entered when awarded. Name of the contact person(s) responsible for corrective action: Director of Community Development Planned completion date for corrective action plan: 5/22/25
Recommendation: We recommend that board members are found, and a board meeting is held. Action Taken: We agree with the auditor and will take under advisement. Anticipated Date of Completion: December 31, 2025
Recommendation: We recommend that board members are found, and a board meeting is held. Action Taken: We agree with the auditor and will take under advisement. Anticipated Date of Completion: December 31, 2025
Recommendation: While we do recognize that the Corporation is not large enough to permit a segregation of duties for effective internal controls, we believe it is important the Corporation be aware that this condition does exist. Action Taken: Management is cognizant of this limitation and will impl...
Recommendation: While we do recognize that the Corporation is not large enough to permit a segregation of duties for effective internal controls, we believe it is important the Corporation be aware that this condition does exist. Action Taken: Management is cognizant of this limitation and will implement additional controls where possible. Anticipated Date of Completion: December 31, 2025
Federal Program: Head Start – ALN 93.600 / 93.356 Awarding Agency: U.S. Department of Health and Human Services (DHHS), Administration for Children and Families (ACF) Finding Reference Number: 2024-001 Condition The SF-425 Federal Financial Report for the period ending December 31, 2024, which was d...
Federal Program: Head Start – ALN 93.600 / 93.356 Awarding Agency: U.S. Department of Health and Human Services (DHHS), Administration for Children and Families (ACF) Finding Reference Number: 2024-001 Condition The SF-425 Federal Financial Report for the period ending December 31, 2024, which was due on January 30, 2025, was submitted late on February 7, 2025. Corrective Action Plan Christian Military Academy, Inc. acknowledges this finding and has implemented corrective measures to ensure compliance with future reporting deadlines: 1. Enhanced Monitoring of PMS Submissions – A reporting calendar with reminders has been established to track all SF-425 deadlines and submission confirmations through the Payment Management System (PMS). 2. Secondary Reviewer – A second staff member has been assigned to review and confirm timely report submissions before each deadline. 3. System Contingency Plan – In the event of PMS malfunctions or access issues, management will immediately notify DHHS/ACF program officers in writing and retain evidence of the communication on or before the due date. 4. Staff Training – Fiscal staff responsible for federal reporting have been trained on the importance of timely submission and the procedures to follow in case of technical issues. Responsible Official Maribel Batista Marrero Christian Military Academy, Inc. Anticipated Completion Date The corrective actions have been implemented as of October 2025 and will remain in place on an ongoing basis.
FINDING 2024-001 – Reporting; Significant Deficiency in Internal Control Over Compliance and Noncompliance Condition and context: Supporting documentation for the quarterly financial reports required by the grant did not include documentation of a review process or filing could not be verified for t...
FINDING 2024-001 – Reporting; Significant Deficiency in Internal Control Over Compliance and Noncompliance Condition and context: Supporting documentation for the quarterly financial reports required by the grant did not include documentation of a review process or filing could not be verified for timely submission. We noted for two of the three reports selected; submission support was not retained by the client. The grantor confirmed submission of all required reports however, the date of submission could not be verified. As such, both reports were determined to have been submitted late. Views of responsible officials and planned corrective actions: Management agrees with the assessment and has implemented corrective action. The Organization has implemented a review and documentation control surrounding the timely submission of all quarterly reports. Calendar reminders will be added to the task list for the compiler of the report information as well as the reviewer/signer of the report. These reminders will be implemented in the work calendars of the employees responsible at the onset of the grant. Reports required by the grant must be submitted timely and must have two levels of documented review. The bookkeeper and project manager will compile the information needed for the grant. The project manager and executive director will review and sign off on the grant report prior to each reporting date. Additionally, report backup and proof of timely submission will be retained by the bookkeeper and project manager. Contact Persons: Phil Champlin – Executive Director Mary Pat Davoren – Bookkeeper
Findings Reported by Uniform Guidance – The following steps have been taken or will be taken to address Finding 2024-007: • Heart City Health Center, Inc. will continue to improvement knowledge and understanding of grant requirements as / if new funding is received to avoid allocating unallowed expe...
Findings Reported by Uniform Guidance – The following steps have been taken or will be taken to address Finding 2024-007: • Heart City Health Center, Inc. will continue to improvement knowledge and understanding of grant requirements as / if new funding is received to avoid allocating unallowed expenses to the grant reimbursement • Heart City Health Center, Inc. started the discussion with HRSA on this funding and will continue to work with them on this funding
View Audit 369664 Questioned Costs: $1
Lincoln County Clerk and Lincoln County Treasurer will review the fiscal report prepared by the third party administrator prior to its submission to the U.S. Treasury.
Lincoln County Clerk and Lincoln County Treasurer will review the fiscal report prepared by the third party administrator prior to its submission to the U.S. Treasury.
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