Corrective Action Plans

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Finding No.: 2022-036 AL Program: 93.767 - Children’s Health Insurance Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Geroge J. Cruz, Medicaid Director Corrective Action Plan: Condition 1: CNMI Medicaid Office respectfully disagrees with this finding. While CNMI Medicaid Office is...
Finding No.: 2022-036 AL Program: 93.767 - Children’s Health Insurance Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Geroge J. Cruz, Medicaid Director Corrective Action Plan: Condition 1: CNMI Medicaid Office respectfully disagrees with this finding. While CNMI Medicaid Office is not the designated entity for submitting SF-425 forms, we recognize the critical importance of these reports in the effective management of federal grant awards. To support overall compliance, the office will proactively coordinate with the submitting agency, the CNMI Department of Finance, by establishing stronger communication protocols. These will include scheduled reminders and regular check-ins with the assigned DOF representative to ensure SF-425 submissions are prioritized and completed ahead of quarterly reporting deadlines. Proposed Completion Date: Ongoing Condition 2: CNMI Medicaid Office respectfully disagrees with this finding. It is unclear where the auditors obtained their reported figures. Based on CMA’s records previously provided to the auditors, the CMS-64 report, and the accounting records agree, with only a $2 difference due to rounding. This alignment is based on the CMS-64 for FY22, Q3, as last revised on October 21, 2022. Proposed Completion Date: Ongoing
Finding No.: 2022-030 AL Program: 21.027 - Coronavirus State and Local Fiscal Recovery Funds Area: Reporting Questioned Costs: $-0- Contact Person(s): Tracy B. Norita, Secretary of Finance Corrective Action Plan: Condition 1-3: The Department of Finance agrees with this finding. It is important to n...
Finding No.: 2022-030 AL Program: 21.027 - Coronavirus State and Local Fiscal Recovery Funds Area: Reporting Questioned Costs: $-0- Contact Person(s): Tracy B. Norita, Secretary of Finance Corrective Action Plan: Condition 1-3: The Department of Finance agrees with this finding. It is important to note that the issue occurred during FY22, a period marked by the transition from the legacy financial system (JDE) to the new Tyler Munis platform. During this time, processes for retaining and reconciling supporting documents had not been standardized, resulting in inconsistencies and a heightened risk of missing or improperly uploaded records. Furthermore, the Program Manager previously responsible for overseeing this grant is no longer with the Department. Due to internal scheduling constraints and the compressed timeline required to complete the FY22 audit, the requested documents were not submitted by the specified deadline, which contributed to this finding. Nevertheless, the Department is committed to provide relevant supporting documentation upon request from the Grantor. Proposed Completion Date: Ongoing.
Finding No.: 2022-028 AL Program: 21.027 - Coronavirus State and Local Fiscal Recovery Funds Area: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Questioned Costs: $33,815,438 Contact Person(s): Tracy B. Norita, Secretary of Finance Corrective Action Plan: Condition 1&6: The Dep...
Finding No.: 2022-028 AL Program: 21.027 - Coronavirus State and Local Fiscal Recovery Funds Area: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Questioned Costs: $33,815,438 Contact Person(s): Tracy B. Norita, Secretary of Finance Corrective Action Plan: Condition 1&6: The Department of Finance agrees with this finding. It is important to note that the issue occurred during FY22, a period marked by the transition from the legacy financial system (JDE) to the new Tyler Munis platform. During this time, processes for retaining and reconciling supporting documents had not been standardized, resulting in inconsistencies and a heightened risk of missing or improperly uploaded records. Furthermore, the Program Manager previously responsible for overseeing this grant is no longer with the Department. Due to internal scheduling constraints and the compressed timeline required to complete the FY22 audit, the requested documents were not submitted by the specified deadline, which contributed to this finding. Nevertheless, the Department is committed to provide relevant supporting documentation upon request from the Grantor. Proposed Completion Date: Ongoing Condition 2-5, 7&8: The Department of Finance respectfully disagrees with this finding. Due to internal scheduling constraints and the compressed timeline required to complete the FY22 audit, the requested documents were not submitted by the specified deadline, resulting in this finding. However, the office maintains all relevant supporting documentation and is prepared to provide it upon request from the Grantor. Proposed Completion Date: Ongoing Condition 9: The Department of Finance agrees with the findings. Following the legal opinion from the CNMI Attorney General’s Office in August 2025, we secured all necessary documentation from the Municipality of Tinian to ensure proper recording and reconciliation of transactions in our financial system. Proposed Completion Date: December 31, 2025
View Audit 371187 Questioned Costs: $1
Finding No.: 2022-026 AL Program: 21.026 - Homeowner Assistance Fund Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Zenie Mafnas, NMHC Director / Tracy B. Norita, Secretary of Finance Corrective Action Plan: The CNMI agrees with this finding. Department of Finance Program Manager ...
Finding No.: 2022-026 AL Program: 21.026 - Homeowner Assistance Fund Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Zenie Mafnas, NMHC Director / Tracy B. Norita, Secretary of Finance Corrective Action Plan: The CNMI agrees with this finding. Department of Finance Program Manager previously responsible for overseeing this grant is no longer with the Department. DOF will work with NMHC to verify whether the required FFATA reports and any other required activities were prepared and submitted to the Subaward Reporting System. Proposed Completion Date: Ongoing
Finding No.: 2022-025 AL Program: 21.023 - Emergency Rental Assistance Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Epiphanio Cabrera, Jr., Grants Administrator, OGM-SC Corrective Action Plan: The Office of Grants Management (OGM) respectfully admits that accurate and timely fin...
Finding No.: 2022-025 AL Program: 21.023 - Emergency Rental Assistance Program Area: Reporting Questioned Costs: $-0- Contact Person(s): Epiphanio Cabrera, Jr., Grants Administrator, OGM-SC Corrective Action Plan: The Office of Grants Management (OGM) respectfully admits that accurate and timely financial reporting was significantly challenged due to systemic and operational factors. First, the CNMI’s financial management system was transitioning from JD Edwards to Tyler-Munis, resulting in shifting expense allocations and fluctuating fund balances throughout the fiscal year. These system migrations inherently delayed reconciliation and reporting of final totals. Additionally, ERA program checks were periodically cancelled or returned by landlords as tenants exercised relocation options to improve housing conditions. These returned or voided payments caused monthly variations in financial reporting figures. OGM communicated these variances and the corresponding fluctuations in the SF-425 reports to Ernst & Young (EY) during the reporting period. It was only several months after the fiscal year’s close that the expenses stabilized, reflecting accurate and reconciled program expenditures. OGM also submitted a narrative report for this reporting period to EY, consistent with federal reporting expectations. It is important to note that the Department of Finance retained primary responsibility for reporting program activities to the U.S. Treasury, and OGM did not have direct access to the Treasury ERA portal. This limitation further constrained OGM’s ability to provide real-time, system-generated reporting. Subsequently, Treasury requested additional metrics and evidence outside the scope of the originally understood deliverables. OGM’s capacity to respond was limited due to these evolving requirements, creating additional reporting challenges. The urgency of OGM assuming responsibility for the ERA program—at the direction of the former Governor—was driven by the state housing agency’s workload related to the concurrent CDBG-Disaster program, which precluded their management of this emergency program. Despite these challenges, OGM provided EY with a comprehensive listing of expenses that reconciled to the FMIS-generated ending fund balance for this business unit. Given these circumstances, OGM asserts that any variances observed in the SF-425 are the result of operational and systemic constraints, and the office should not be penalized for discrepancies arising under these extraordinary conditions. Subsequently, all ERA1 Reporting were resolved in February 2025 with US Treasury. This action closed the grant officially. Proposed Completion Date: Ongoing.
Finding No.: 2022-018 AL Program: 15.875 - Economic, Social, and Political Development of the Territories Area: Reporting Questioned Costs: $-0- Contact Person(s): Nerissa B. Karakaya, CIP COTR Corrective Action Plan: CIP agrees with this finding. A documentation checklist exists; however, it was no...
Finding No.: 2022-018 AL Program: 15.875 - Economic, Social, and Political Development of the Territories Area: Reporting Questioned Costs: $-0- Contact Person(s): Nerissa B. Karakaya, CIP COTR Corrective Action Plan: CIP agrees with this finding. A documentation checklist exists; however, it was not consistently fully extended to program administration records. Monitoring controls focused primarily on project completion, resulting in less attention to verifying that supporting documentation for administrative expenses was fully compiled and properly reconciled. In addition, segregation-of-duties constraints were evident, as the same staff oversaw both the preparation of reports and the maintenance of program administration records, which limited independent verification and delayed the retrieval of required documentation. The following steps will be implemented to address this finding. 1. Implement Formal Monitoring Procedures • Develop and document a standardized review checklist to verify that all data in financial and operational reports is supported by source documentation and reconciled to the accounting records. • Require periodic management sign-off (e.g., monthly or quarterly) to confirm that reconciliations are performed and retained. 2. Strengthen Segregation of Duties • Reassign key tasks so that data preparation, reconciliation, and approval are performed by separate individuals or units whenever possible. • Where staffing constraints prevent full segregation, implement compensating controls (e.g., independent supervisory review, dual sign-off). 3. Training and Capacity Building • Provide targeted training to finance and program staff on proper documentation, reconciliation procedures, and the importance of segregation of duties. 4. Periodic Internal Reviews • Establish periodic internal audits or spot checks by an independent unit (e.g., internal audit or compliance team) to verify adherence to the new monitoring controls and segregation requirements. 5. Timeline for Implementation • Within 30 days: Draft and approve written monitoring and reconciliation procedures. • Within 60 days: Reassign tasks to strengthen segregation of duties or document compensating controls. • Within 90 days: Conduct staff training and begin periodic internal reviews. 6. Monitoring & Reporting • Quarterly management reports to track completion of reconciliations and internal review results. • Annual evaluation of control design and effectiveness by internal audit or an independent reviewer. These actions will ensure reported data is consistently supported by accurate underlying accounting records and controls are suitably designed and effective, reducing the risk of misstatement or undetected errors due to inadequate segregation of duties. Proposed Completion Date: December 31, 2025
The City anticipates being able to complete the next audit timely which will lead to a timely submission of the data collection form.
The City anticipates being able to complete the next audit timely which will lead to a timely submission of the data collection form.
Finding Reference: 2022-002 Compliance with Reporting to Housing and Urban Development Description: The financial information submission was not submitted timely. Recommendation: The Town should follow federal guidelines by submitting the audited financial statement to HUD through the REAC submissio...
Finding Reference: 2022-002 Compliance with Reporting to Housing and Urban Development Description: The financial information submission was not submitted timely. Recommendation: The Town should follow federal guidelines by submitting the audited financial statement to HUD through the REAC submission in a timely manner. Corrective Action: The Town of Guilderland Comptroller’s Office suffered significant turnover in key positions during the fiscal years of 2019 and 2021 including the retirement of the Town Comptroller and Fiscal Officer. In addition, the COVID-19 pandemic had significant impact to the Town, particularly during 2020 when remote work was encouraged. This combination and sequence of events made it impossible to meet the required external audit reporting deadlines. Since these events, the Town has filed the vacant positions and has scheduled all remaining audits. The auditors are working as expeditiously as possible to complete the remaining audits. The Town receives an accepted audited REAC submission from HUD each year and has been submitting timely since 2022. Once the audited financial statements are caught up, they will be included in the REAC submission timely. Person(s) Responsible for Corrective Action: Darci Efaw, Comptroller & Jessica Gulliksen, Fiscal Officer Anticipated Completion Date for Corrective Action: The remaining audits that are left to become fully in compliance have been tentatively scheduled with the external auditors since 2022. The Town of Guilderland works as efficiently as possible with the auditors to complete these remaining audits.
Finding Reference: 2022-001 Compliance with Reporting Under the Uniform Guidance Description: The data collection forms for the years 2019 through 2021 have not been submitted timely. Recommendation: The Town should follow federal guidelines by submitting the data collection form to the FAC in a tim...
Finding Reference: 2022-001 Compliance with Reporting Under the Uniform Guidance Description: The data collection forms for the years 2019 through 2021 have not been submitted timely. Recommendation: The Town should follow federal guidelines by submitting the data collection form to the FAC in a timely manner. Corrective Action: The Town of Guilderland Comptroller’s Office suffered significant turnover in key positions during the fiscal years of 2019 and 2021 including the retirement of the Town Comptroller and Fiscal Officer. The Town also implemented a new accounting software during 2018 that caused significant delays in the monthly and year-end reporting. Lastly, the COVID-19 pandemic had significant impact to the Town, particularly during 2020 when remote work was encouraged. This combination and sequence of events made it impossible to meet the required external audit reporting deadlines. Since these events, the Town has filed the vacant positions and has scheduled all remaining audits. The auditors are working as expeditiously as possible to complete the remaining audits. The required reporting noted in the guidelines above cannot be completed until each prior year audit is finished, therefore causing a delay in each fiscal year’s reporting. Person(s) Responsible for Corrective Action: Darci Efaw, Comptroller & Jessica Gulliksen, Fiscal Officer Anticipated Completion Date for Corrective Action: The data collection forms for years 2018 through 2022 have been filed. The remaining audits that are left to become fully in compliance have been tentatively scheduled with the external auditors since 2022. The Town of Guilderland works as efficiently as possible with the auditors to complete these remaining audits. The remaining data collection forms will be filed upon completion of the audits.
Finding 2022-001: Uniform Guidance Audit Requirement Responsible Individuals: Jeannie Walters, Finance Officer Corrective Action Plan: The Association will work to complete future audits timely. Anticipated Completion Date: Future federal programs
Finding 2022-001: Uniform Guidance Audit Requirement Responsible Individuals: Jeannie Walters, Finance Officer Corrective Action Plan: The Association will work to complete future audits timely. Anticipated Completion Date: Future federal programs
Reporting – Education Stabilization Funds INDIVIDUAL RESPONSIBLE: Business Manager and Federal Grants Director ANTICIPATED COMPLETION DATE: FY2026 CORRECTIVE ACTION PLAN: At this point in time the ESSR funds are no longer available, so there will not be any other documentation going forward. However...
Reporting – Education Stabilization Funds INDIVIDUAL RESPONSIBLE: Business Manager and Federal Grants Director ANTICIPATED COMPLETION DATE: FY2026 CORRECTIVE ACTION PLAN: At this point in time the ESSR funds are no longer available, so there will not be any other documentation going forward. However, with other grants the processes have changed. Since FY2022 an accounting firm was hired to catch the school district up on grant requests. This accountant requested funds on a quarterly basis. On July 1, 2025, the District hired a Federal Grants Director to work with the Business Manager to complete the grant catch up process and to create a system that documents each expenditure and the timing of the requests. Once the system is in place cash requests will be completed monthly.
Unsupported Expenditures – Education Stabilization Funds INDIVIDUAL RESPONSIBLE: Business Manager and Federal Grants Director ANTICIPATED COMPLETION DATE: FY2026 CORRECTIVE ACTION PLAN: At this point in time the ESSR funds are no longer available, so there will not be any other documentation going f...
Unsupported Expenditures – Education Stabilization Funds INDIVIDUAL RESPONSIBLE: Business Manager and Federal Grants Director ANTICIPATED COMPLETION DATE: FY2026 CORRECTIVE ACTION PLAN: At this point in time the ESSR funds are no longer available, so there will not be any other documentation going forward. However, with other grants the processes have changed. Since FY2022 an accounting firm was hired to catch the school district up on grant requests. This accountant requested funds on a quarterly basis. On July 1, 2025, the District hired a Federal Grants Director to work with the Business Manager to complete the grant catch up process and to create a system that documents each expenditure and the timing of the requests. Once the system is in place cash requests will be completed monthly.
View Audit 370564 Questioned Costs: $1
Reporting: The College agrees with the finding. To address the repeat finding, the College will implement a standardized reporting check list and a calendar utilizing its Asana Project Management tool to track and monitor all required federal and grant deadlines.
Reporting: The College agrees with the finding. To address the repeat finding, the College will implement a standardized reporting check list and a calendar utilizing its Asana Project Management tool to track and monitor all required federal and grant deadlines.
Reporting College of the Marshall Islands acknowledges the finding and agrees that both the Section II source data file of the Annual Performance Report (APR) and the required Final Performance Report could not be provided during the audit. This occurred due to inadequate internal controls and the l...
Reporting College of the Marshall Islands acknowledges the finding and agrees that both the Section II source data file of the Annual Performance Report (APR) and the required Final Performance Report could not be provided during the audit. This occurred due to inadequate internal controls and the limitations of the previous manual filing system, which led to incomplete retention and difficulty retrieving submitted reports during the audit fieldwork. To correct this, the College has upgraded and institutionalized a cloud-based filing system to ensure all source data files, APR submissions, and Final Performance Reports are properly stored, organized, and easily accessible. Internal control policies and procedures have been strengthened to require that all performance reports are submitted on time, with verified source data and confirmation of successful submission retained in the system. The TRIO Office has established a reporting calendar, supervisory review process, and digital archive protocol to ensure all APR and final reports are prepared, submitted, and properly retained. With the upgraded systems and the support of newly hired skilled staff, the College is now better equipped to meet federal reporting requirements. Staff have been trained— and will continue to be trained twice a year—on performance reporting procedures and federal reporting standards to prevent recurrence of similar issues in future audits.
Views of Responsible Officials and Corrective Action: Us Helping Us acknowledges the audit finding regarding delays in completing the annual audit and submitting the required reporting package and data collection form to the Federal Audit Clearinghouse (FAC), as required under 2 CFR § 200.512. The o...
Views of Responsible Officials and Corrective Action: Us Helping Us acknowledges the audit finding regarding delays in completing the annual audit and submitting the required reporting package and data collection form to the Federal Audit Clearinghouse (FAC), as required under 2 CFR § 200.512. The organization further recognizes that the audit and reporting package must be submitted within 30 calendar days after receipt of the auditor’s report or nine months after the end of the audit period, whichever is earlier. To address this issue and prevent recurrence, Us Helping Us will implement the following measures: Audit Timeline Planning: Us Helping Us has developed a detailed audit calendar with milestones for document preparation, auditor engagement, and internal review. The FY2023 Audit is scheduled for a December 2025 completion, FY2024 and FY2025 audits are scheduled for completion in March 2026 and August 2026 respectively. The organization is working on staffing improvements and plan on having key vacancies in our finance department filled and plan on providing training on audit readiness and Federal reporting requirements. Specifically, Us Helping Us is hiring for a Deputy Executive Director for Finance and Administration as well as a Finance Manager. These positions are scheduled to be filled by the end of September 2025. Next, Us Helping Us uses the updated FAC portal launched by the General Services Administration to ensure accurate and complete submissions In accordance with Federal guidance, Us Helping Us will documented the reasons for the delayed submission and retained this documentation for review by oversight agencies. We understand that while extensions may be granted under certain circumstances, timely submission is critical to maintaining our status as a low-risk auditee. Us Helping Us is committed to full compliance with Uniform Guidance and Federal audit requirements. The organization will continue to work to resolve this finding and ensure timely submissions in future years.
2022-001: Data Collection Form and Single Audit Reporting Package VIEDA Response: The Authority recognizes the importance of timely Single Audit submissions to maintain compliance and low-risk auditee status. Delays in completing the audit process affected the FY2022, FY2023, and FY2024 cycles, and ...
2022-001: Data Collection Form and Single Audit Reporting Package VIEDA Response: The Authority recognizes the importance of timely Single Audit submissions to maintain compliance and low-risk auditee status. Delays in completing the audit process affected the FY2022, FY2023, and FY2024 cycles, and residual timing challenges may impact the FY2025 deadline. However, process improvements including a formal Single Audit calendar, monthly progress monitoring, and cross-training of staff are now in place and are expected to ensure full compliance beginning with the FY2026 audit cycle. Estimated Completion Date: Ongoing Contact: Kelly Thompson Webbe, Chief Financial Officer
Management has contracted with a contract accountant who has already started audit preparation services for future audits. The 2022 has been started and will be completed shortly. The 2023 audit will be started shortly. The Native Village expects to be fully caught up by their fiscal year 2025 audit...
Management has contracted with a contract accountant who has already started audit preparation services for future audits. The 2022 has been started and will be completed shortly. The 2023 audit will be started shortly. The Native Village expects to be fully caught up by their fiscal year 2025 audit.
Management will ensure that all required grant reporting, both financial and/or narrative/programmatic will be prepared and submitted timely. The final reporting for the Treasury CARES ACT has been completed and submitted subsequent to year end.
Management will ensure that all required grant reporting, both financial and/or narrative/programmatic will be prepared and submitted timely. The final reporting for the Treasury CARES ACT has been completed and submitted subsequent to year end.
Planned Corrective Action: ACCEPT was approved by the Nevada Department of Public and Behavioral Health to submit RFRs as soon as possible in FY22. ACCEPT has followed this approval and submitted all requests by the 15th day of the month following the aforementioned month. Name of Contact Person: Gw...
Planned Corrective Action: ACCEPT was approved by the Nevada Department of Public and Behavioral Health to submit RFRs as soon as possible in FY22. ACCEPT has followed this approval and submitted all requests by the 15th day of the month following the aforementioned month. Name of Contact Person: Gwen Taylor, Executive Director
Planned Corrective Action: The Quality Management Director and Executive Director have worked together to create a process with appropriate checks and balances regarding moving expense across individual grants and major funds. This process will consist of multiple levels of approval and specific doc...
Planned Corrective Action: The Quality Management Director and Executive Director have worked together to create a process with appropriate checks and balances regarding moving expense across individual grants and major funds. This process will consist of multiple levels of approval and specific documentation. Any entries will be processed in a timely manner and all expenditure reports will be checked for errors monthly. This process will ensure that expenditure reports are accurate at the time they are submitted for reimbursement. Name of Contact Person: Gwen Taylor, Executive Director
We concur with the finding. The ETA 9130 reports for FY22 were based on estimates due to limitations in the reliability of the WIOA accounting system at that time.
We concur with the finding. The ETA 9130 reports for FY22 were based on estimates due to limitations in the reliability of the WIOA accounting system at that time.
PAX will establish appropriate policies, procedures, and controls to ensure that future submissions of Uniform Guidance reports are filed timely. The primary deliverable will be timely audit completion and submission.
PAX will establish appropriate policies, procedures, and controls to ensure that future submissions of Uniform Guidance reports are filed timely. The primary deliverable will be timely audit completion and submission.
In a previous period and by previous auditors, PAX was told that because we were using a percentage of effort calculation in budgeting that time sheets were no longer needed for this purpose. At that time, we abandoned the time sheet process (which was arduous). Based upon current auditor’s advice, ...
In a previous period and by previous auditors, PAX was told that because we were using a percentage of effort calculation in budgeting that time sheets were no longer needed for this purpose. At that time, we abandoned the time sheet process (which was arduous). Based upon current auditor’s advice, PAX established an effort verification reporting system. This system was launched in FY23 and enhanced in FY24. It will accurately capture the effort spent by each employee on specific grants, ensuring proper documentation of allocation of wages and salaries to the respective federal awards.
View Audit 370331 Questioned Costs: $1
The Government concurs with the auditor's findings and recommendations. A process related to financial and performance report preparation and submission will be formalized, and clear roles/responsibilities will be outlined. The Disaster Program Account Supervisors will be responsible for preparing t...
The Government concurs with the auditor's findings and recommendations. A process related to financial and performance report preparation and submission will be formalized, and clear roles/responsibilities will be outlined. The Disaster Program Account Supervisors will be responsible for preparing the reports on a quarterly basis and submitting them to the Territorial Hazard Mitigation Officer for review. The review process will include thorough reconciliation between the reports and other supporting data, such as accounting records.
The Government concurs with the auditor's findings and recommendations. The formalized process related to financial and performance report preparation and submission is now in place with clear roles and responsibilities outlined. The Disaster Program Financial Specialist is responsible for preparing...
The Government concurs with the auditor's findings and recommendations. The formalized process related to financial and performance report preparation and submission is now in place with clear roles and responsibilities outlined. The Disaster Program Financial Specialist is responsible for preparing the reports quarterly and submitting them to the Territorial Public Assistance Officer for review. The review process includes thorough reconciliations between the reports and other supporting data, such as accounting records.
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