Corrective Action Plans

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Program: AL 21.026 ? COVID-19 Homeowner Assistance Fund ? Subrecipient Monitoring Corrective Action Plan: N/A Contact: Major General Daryl Bohac Anticipated Completion Date: N/A
Program: AL 21.026 ? COVID-19 Homeowner Assistance Fund ? Subrecipient Monitoring Corrective Action Plan: N/A Contact: Major General Daryl Bohac Anticipated Completion Date: N/A
View Audit 55212 Questioned Costs: $1
Program: AL 21.023 ? COVID-19 Emergency Rental Assistance ? Allowability & Eligibility Corrective Action Plan: N/A Contact: Lee Will Anticipated Completion Date: N/A
Program: AL 21.023 ? COVID-19 Emergency Rental Assistance ? Allowability & Eligibility Corrective Action Plan: N/A Contact: Lee Will Anticipated Completion Date: N/A
View Audit 55212 Questioned Costs: $1
Finding 59850 (2022-058)
Significant Deficiency 2022
Program: AL 20.933 ? National Infrastructure Investments ? Reporting Corrective Action Plan: NDOT will finalize in coordination with FHWA a standard operating procedure for the quarterly SF-425 reporting process as well as generate a standard operating procedure for FFATA reporting. Contact: Khali...
Program: AL 20.933 ? National Infrastructure Investments ? Reporting Corrective Action Plan: NDOT will finalize in coordination with FHWA a standard operating procedure for the quarterly SF-425 reporting process as well as generate a standard operating procedure for FFATA reporting. Contact: Khalil Jaber Anticipated Completion Date: June 2023
Program: AL 20.509 ? Formula Grants for Rural Areas ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Controller Division, Audit Section, will provide support through continued engagement and work collaboratively as an additional resource to the NDOT Transit staff and transit rec...
Program: AL 20.509 ? Formula Grants for Rural Areas ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Controller Division, Audit Section, will provide support through continued engagement and work collaboratively as an additional resource to the NDOT Transit staff and transit recipients. NDOT Transit staff in collaboration with the Controller Division will be improving the standard operating Procedures which will be utilized for the in-depth review of monthly invoices moving forward. Contact: Khalil Jaber Anticipated Completion Date: Ongoing
View Audit 55212 Questioned Costs: $1
Program: AL 20.205 ? Highway Planning & Construction ? Subrecipient Monitoring Corrective Action Plan: NDOT will review all current active subaward agreements and verify federal subaward identification information is included. If information was not previously included in the original agreement or ...
Program: AL 20.205 ? Highway Planning & Construction ? Subrecipient Monitoring Corrective Action Plan: NDOT will review all current active subaward agreements and verify federal subaward identification information is included. If information was not previously included in the original agreement or a supplement agreement, NDOT will provide a supplemental award notice to notify the subrecipient of the subaward identification information as required by 2 CFR ? 200.332. Contact: Khalil Jaber Anticipated Completion Date: September 2023
View Audit 55212 Questioned Costs: $1
Program: AL 93.778 ? Medical Assistance Program; AL 93.767 ? Children?s Health Insurance Program (CHIP) ? Special Tests and Provisions Corrective Action Plan: The Provider Relations team will do the following to mitigate the finding: 1. Develop educational materials about the requirements to disc...
Program: AL 93.778 ? Medical Assistance Program; AL 93.767 ? Children?s Health Insurance Program (CHIP) ? Special Tests and Provisions Corrective Action Plan: The Provider Relations team will do the following to mitigate the finding: 1. Develop educational materials about the requirements to disclose managing employees and post to the DHHS webpage. 2. Identify up to 25 providers that have not listed any managing employees and educate them directly about the need to review the federal law, determine if they have managing employees, and update their provider agreement. 3. Randomly select 25 providers and review the managing employee information they have disclosed. Direct the provider to correct their provider agreement when necessary. Contact: Anne Harvey; Zac Ross; Melinda Abbott Anticipated Completion Date: 06/30/2023
View Audit 55212 Questioned Costs: $1
Program: AL 93.575 ? Child Care and Development Block Grant - Allowable Costs/Cost Principles Corrective Action Plan: The Agency will review procedures and ensure that all cost centers are properly reconciled. Contact: Rebecca Kempkes Anticipated Completion Date: 6/30/2023
Program: AL 93.575 ? Child Care and Development Block Grant - Allowable Costs/Cost Principles Corrective Action Plan: The Agency will review procedures and ensure that all cost centers are properly reconciled. Contact: Rebecca Kempkes Anticipated Completion Date: 6/30/2023
View Audit 55212 Questioned Costs: $1
Program: AL 93.568 ? Low-Income Home Energy Assistance (LIHEAP) ? Reporting Corrective Action Plan: The Agency will develop a process with the Nebraska Department of Environment and Energy to communicate with LIHEAP Staff when they have awarded LIHEAP funds to subrecipients. The process will includ...
Program: AL 93.568 ? Low-Income Home Energy Assistance (LIHEAP) ? Reporting Corrective Action Plan: The Agency will develop a process with the Nebraska Department of Environment and Energy to communicate with LIHEAP Staff when they have awarded LIHEAP funds to subrecipients. The process will include the requirement for LIHEAP Staff to provide the FFATA information to the staff that are responsible for FFATA reporting, so it is submitted timely. In addition, the Agency will revise the logic in the LIHEAP Federal Fiscal Year Report to ensure the data for the Household Report is accurate. Contact: Rebecca Kempkes / Matt Thomsen Anticipated Completion Date: 10/01/2023
Program: AL 93.558 ? Temporary Assistance for Needy Families (TANF) ? Reporting Corrective Action Plan: The Agency will develop a process to ensure that ACF204 reporting is submitted timely to ACF and in the OLDC portal. In addition, the Agency will develop a process to identify hybrid contracts ...
Program: AL 93.558 ? Temporary Assistance for Needy Families (TANF) ? Reporting Corrective Action Plan: The Agency will develop a process to ensure that ACF204 reporting is submitted timely to ACF and in the OLDC portal. In addition, the Agency will develop a process to identify hybrid contracts to ensure FFATA reporting. Contact: Rebecca Kempkes / Snita Soni Anticipated Completion Date: 10/30/2023
Program: AL 93.323 - COVID-19 Epidemiology & Laboratory Capacity for Infectious Diseases ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Agency had already initiated a process with Ford Storage to resolve contract compliance issues at the time APA began its review and shared t...
Program: AL 93.323 - COVID-19 Epidemiology & Laboratory Capacity for Infectious Diseases ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Agency had already initiated a process with Ford Storage to resolve contract compliance issues at the time APA began its review and shared this with APA, as noted above. The Agency coordinated a full inventory of warehouse supplies and verified the appropriate pallet count payment tier. The Agency will require Ford to repay or credit back $32,200 as a result of this inventory validation, which includes the above questioned costs of $16,100. For LHD, the Agency will formalize its approval of a budget shift to contract services under the subaward via an amendment to the agreement. Other contracts referenced in the finding have since ended, no corrective action plan is necessary. Contact: Ryan Daly, Felicia Quintana-Zinn, Caryn Vincent, Brenda Soto Anticipated Completion Date: 1/31/23
View Audit 55212 Questioned Costs: $1
Program: AL 93.069 ? Public Health Emergency Preparedness (PHEP); AL 93.889 ? National Bioterrorism Hospital Preparedness Program (HPP) ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Department will require subrecipients with inadequate support for costs in APA's sample to par...
Program: AL 93.069 ? Public Health Emergency Preparedness (PHEP); AL 93.889 ? National Bioterrorism Hospital Preparedness Program (HPP) ? Allowability & Subrecipient Monitoring Corrective Action Plan: The Department will require subrecipients with inadequate support for costs in APA's sample to participate in technical assistance sessions focused on allocability of costs to federal awards, which appears a common theme in APA's questioned cost sample. Costs within the questions costs total that DHHS determines are unsupported will be disallowed. With staffing resources now in place, the PHEP/HPP cluster will be able to adhere to DHHS monitoring practices. Contact: Lisa Osborne / Ryan Daly Anticipated Completion Date: 06/30/2023
View Audit 55212 Questioned Costs: $1
Program: AL 84.010 ? Title I Grants to Local Educational Agencies ? Allowability and Subrecipient Monitoring Corrective Action Plan: The Department will contact the two subrecipients noted to provide one-on-one technical assistance and will also provide additional technical assistance regarding pro...
Program: AL 84.010 ? Title I Grants to Local Educational Agencies ? Allowability and Subrecipient Monitoring Corrective Action Plan: The Department will contact the two subrecipients noted to provide one-on-one technical assistance and will also provide additional technical assistance regarding proper time and effort documentation to all subrecipients. Additionally, time and effort guidance is available to all subrecipients on the Department?s website, will be discussed at upcoming subrecipient training opportunities and supported by a dedicated Grants Management Training Specialist. The Department will ensure the identified written deficiencies noted in the subrecipient fiscal monitoring exit letter clearly identifies a finding vs. technical assistance needed; whereas a finding is supported by follow-up in accordance with federal UGG regulations and technical assistance provides knowledge of the Department?s training and resources available. Contact: Jen Utemark, Budget and Grants Management Anticipated Completion Date: December 31, 2023
View Audit 55212 Questioned Costs: $1
Finding 59799 (2022-049)
Significant Deficiency 2022
Program: AL 12.400 ? Military Construction, National Guard ? Suspension and Debarment Corrective Action Plan: Contracting Officers are logging into SAM website, looking up the Contractor or A&E to ensure that they are not barred. We are taking a screen shot of the web site printing it off and attac...
Program: AL 12.400 ? Military Construction, National Guard ? Suspension and Debarment Corrective Action Plan: Contracting Officers are logging into SAM website, looking up the Contractor or A&E to ensure that they are not barred. We are taking a screen shot of the web site printing it off and attaching it to our digital/hard copy files. Contact: MAJ Justin Portenier Anticipated Completion Date: The Corrective Action Plan has already been implemented and will be updated in the Standard Operating Procedure Manual (SOP) no later than 30-May-2023.
Finding 59797 (2022-023)
Significant Deficiency 2022
Program: Various, including AL 10.561 ? State Administrative Matching Grants for the Supplemental Nutrition Assistance Program; AL 93.558 ? Temporary Assistance for Needy Families; AL 93.566 ? Refugee and Entrant Assistance State/Replacement Designee Administered Programs; AL 93.575 ? Child Care and...
Program: Various, including AL 10.561 ? State Administrative Matching Grants for the Supplemental Nutrition Assistance Program; AL 93.558 ? Temporary Assistance for Needy Families; AL 93.566 ? Refugee and Entrant Assistance State/Replacement Designee Administered Programs; AL 93.575 ? Child Care and Development Block Grant ? Allowable Costs/Cost Principles Corrective Action Plan: Several areas within DHHS are currently working to improve upon the process of determining how staff are paid during the hiring process and when turnover occurs. Contact: Patrick Werner Anticipated Completion Date: 02/01/2024
View Audit 55212 Questioned Costs: $1
Finding Number: 2022-002 Program: 14.218 ? Community Development Block Grant Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Condition: Prince George?s Count...
Finding Number: 2022-002 Program: 14.218 ? Community Development Block Grant Compliance Requirement: Reporting ? Federal Funding Accountability and Transparency Act (FFATA) Type of Finding: Material Weakness in Internal Control Over Compliance, Material Noncompliance Condition: Prince George?s County (County) did not report required subaward information to FSRS for first-tier subawards of $30,000 or more. Cause: The County?s policies and procedures were not sufficient to ensure that required subaward information was reported to FSRS. Internal controls did not prevent or detect the errors. Resolution: DHCD established Policies and Procedures governing all entitlement programs, including the Community Development Block Grant Program. DHCD will provide the Office of Management of Budget (OMB) with all subawards of $30,000 or more monthly to upload into the FSRS system. Responsible Party: Aspasia Xypolia, Director, DHCD Anticipated corrective action plan completion date: The Department will coordinate with OMB to upload the required data of the sub awardees receiving $30,000 or more in entitlement funds. DHCD has the necessary sub-awardee data for current and prior years to begin updating the required data. Any questions concerning the findings or corrective action plan can be directed to Aspasia Xypolia, Director, DHCD at 301-883- 6511.
FINDING 2022-001 Contact Person Responsible for Corrective Action: Yvonne Hoffmaster Contact Phone Number: 219 873-1404 Ext. 2004 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: To bring the City into compliance with effective internal controls to en...
FINDING 2022-001 Contact Person Responsible for Corrective Action: Yvonne Hoffmaster Contact Phone Number: 219 873-1404 Ext. 2004 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: To bring the City into compliance with effective internal controls to ensure requirements related to the grant agreement and the Suspension and Debarment are satisfied, the City has created a checklist, Exhibit A, that contain a sign off by the Department Head and Board of Works as necessary. Anticipated Completion Date: The checklist will begin to be utilized on May 1, 2023.
Finding: 2022-004 Name of Contact Person: Jeremy Christiansen, Superintendent Corrective Action: The District relies on the auditor to propose adjustments necessary to prepare the schedule of expenditures of federal awards including the related note disclosures. The District reviews the schedul...
Finding: 2022-004 Name of Contact Person: Jeremy Christiansen, Superintendent Corrective Action: The District relies on the auditor to propose adjustments necessary to prepare the schedule of expenditures of federal awards including the related note disclosures. The District reviews the schedule of expenditures of federal awards and approves all adjustments. Proposed Completion Date: Immediately
Finding 2022-001: Gramm-Leach Bliley Act (GLBA) Recommendation: The University should perform and document an annual risk assessment to determine the University's specific risks relevant to protecting consumer nonpublic personal information. At a minimum, the University should have at least one risk...
Finding 2022-001: Gramm-Leach Bliley Act (GLBA) Recommendation: The University should perform and document an annual risk assessment to determine the University's specific risks relevant to protecting consumer nonpublic personal information. At a minimum, the University should have at least one risk statement aligned or referenced to each of the three required areas noted in the GLBA law at 16 CFR 314.4 (b). Finally, the University should identify and document at least one safeguard (i.e., control) for each of the risks identified and document in the risk assessment. Each control should be aligned or referenced to the risk(s) to which the safeguard applies. Action Taken: The University has taken the following steps to address the risks identified during the audit: 1. Employee Training and Management a. The University deployed the Knowbe4 Security Awareness Program to all full time staff. The program provides training for managing user data and email messages. To date the University has distributed two campaigns to combat email phishing attempts. 2. Information systems, including network and software design, as well as information processing, storage, transmission and disposal a. The University has formulated a digital transformation strategy to reduce on premises systems and applications. All the critical business systems are hosted at a colocation or are SaaS solutions. b. The University performs backups of all on premises systems using technology that creates immutable storage. c. The University leverages the cybersecurity experience of resellers and manufacturers to ensure all core network technology is installed and configured to minimize any attack surface. 3. Detecting, preventing, and responding to attacks, intrusions, or other systems failures and document safeguards for identified risks as required by the Gramm-Leach Bliley Act (GLBA). a. The University has deployed a redundant pair of Fortinet Advanced Firewalls to monitor and block traffic with suspicious payloads. b. The University has updated to the latest version of Microsoft Advanced Threat Defender to serve as optimal end point protection for managing email traffic. c. The University contracted with the Cybersecurity and Infrastructure Security Agency (CISA) to perform vulnerability scans and penetration testing. The IT department evaluates the weekly reports and remediates highlighted deficiencies. d. The University has removed all admin rights from school managed computers, eliminating the ability to install local software. e. The University has deployed an updated VPN client to all school managed computers providing a secure tunnel for access network services. f. The University manages web browsers of all school managed computers. The University will take the results of the security assessment that was completed and draft the GLBA policy in conformity with the DOE requirements by June 2023. Responsible Individual for Corrective Action: Chief Information Officer ? Gregg Chottiner Anticipated Completion Date: June 30, 2023
Tri-County North will make sure that we follow the proper controls on wage requirements and standards to make sure that the contractor is in compliance with prevailing wage rate.
Tri-County North will make sure that we follow the proper controls on wage requirements and standards to make sure that the contractor is in compliance with prevailing wage rate.
Finding: Reports of commodity activity were submitted to the pass-through entity that were not consistent with the underlying commodities records of RKCAA. Corrective Response: RKCAA management agrees with the finding. RKCAA is updating and revising policies and procedures, including additional sup...
Finding: Reports of commodity activity were submitted to the pass-through entity that were not consistent with the underlying commodities records of RKCAA. Corrective Response: RKCAA management agrees with the finding. RKCAA is updating and revising policies and procedures, including additional supervision, training and reconciliations to better track and report the commodities activity to the pass-through entity. This process is expected to be completed by June 30, 2023. 06/30/2023 CFO Laura Brown 262-637-8377 ext 104
Finding: 2022-002 ? Material Weakness, Internal Control Over Compliance, Eligibility and Special Tests ? ALN 93.778 Medicaid Cluster Personnel Responsible for Corrective Action: Pam Noonan, Mesa County Finance Director Anticipated Completion Date: 09/29/2023 Cause: Internal controls over the el...
Finding: 2022-002 ? Material Weakness, Internal Control Over Compliance, Eligibility and Special Tests ? ALN 93.778 Medicaid Cluster Personnel Responsible for Corrective Action: Pam Noonan, Mesa County Finance Director Anticipated Completion Date: 09/29/2023 Cause: Internal controls over the eligibility determinations are the responsibility of management. Mesa County did not follow its formal process in place for reviews of eligibility determinations. View of Responsible Officials and Planned Corrective Action: Mesa County agrees with the finding and has put together a corrective action plan for the finding. Corrective Action Plan: Mesa County was aware that they were not meeting their internal or Health Care Policy and Financing (HCPF) and Colorado Department of Human Services (CDHS) review requirements for 2022. Mesa County created a new quality control case reviews policy and procedure effective June 2023. The new policy included internal, HCPF and CDHS review requirement for all programs. In addition, MCDHS quality assurance team will be providing oversight using a tool they create to ensure review requirements are being met for each program.
Finding: 2022-001 ? Material Weakness, Compliance and Internal Control over Compliance, Subrecipient Monitoring ? ALN 21.027 Coronavirus State and Local Fiscal Recovery Funds Personnel Responsible for Corrective Action: Pam Noonan, Mesa County Finance Director Anticipated Completion Date: 12/31/20...
Finding: 2022-001 ? Material Weakness, Compliance and Internal Control over Compliance, Subrecipient Monitoring ? ALN 21.027 Coronavirus State and Local Fiscal Recovery Funds Personnel Responsible for Corrective Action: Pam Noonan, Mesa County Finance Director Anticipated Completion Date: 12/31/2023 Cause: Mesa County embarked on the usual funding methodology of capitalizing on private investments in our low-income community, whereby a much-needed training facility and daycare is nonexistent, by utilizing New Market Tax Credits. Due to the complexity of the arrangement and the lack of adequate information provided by consultants, determinations and documentation of the subrecipient did not occur prior to granting funds to the recipient organization. View of Responsible Officials: Mesa County agrees with the finding and has put together a corrective action plan for the finding. Planned Corrective Action: Mesa County will develop procedures and educate County departments in order to ensure compliance with the grant management policy and subrecipient language included therein. Mesa County will formally communicate with the subrecipient organization the necessary Federal award identifiers and expected continued compliance and required documentation during the performance period.
Finding 2022-002 Activities Allowed or Unallowed and Allowable Costs/Cost Principles A material weakness in internal control over compliance was issued related to activities allowed or unallowed and allowable costs/cost principles for the Advocate Aurora Health (AAH) Disaster Grant ? Public Assista...
Finding 2022-002 Activities Allowed or Unallowed and Allowable Costs/Cost Principles A material weakness in internal control over compliance was issued related to activities allowed or unallowed and allowable costs/cost principles for the Advocate Aurora Health (AAH) Disaster Grant ? Public Assistance (Presidentially Declared Disasters). The Organization?s internal controls were not suitably designed to retain all supporting documentation over their review and approval of FEMA federal expenditures. Management did not retain supporting documentation to support the inventory usage reports used in the development of the FEMA expenditures. Management will ensure that a comprehensive review, approval, and document retention process is applied consistently for any future FEMA claims. The FEMA personal protective equipment (PPE) claim covered two years, which are 2020 and 2021. As noted in the audit, the Organization engaged a third party to perform a physical inventory of supplies at December 31, 2020 which included the PPE claimed in the SEFA obligation. The physical inventory was reconciled to the inventory management system. The audit selected a sample inventory count performed by third party and agreed the inventory counts back to the third party records noting no exceptions. A physical inventory was not performed at December 31, 2021. Due to the COVID pandemic, there were unusual circumstances that precluded an annual physical inventory in 2021, due to the easy transmission of COVID-19, by breathing in air carrying droplets or aerosol particles that contain the SARS-CoV-2 virus when close to an infected person or in poorly ventilated spaces with infected persons. Noting there were no system changes to the inventory system during 2021, we relied on the prior year audits and internal control review of the inventory system to provide comfort for the Organization for reliance on the inventory usage for this FEMA claim. In addition to relying on past inventory documented audit controls, the Organization routinely reviews the supply expense generated from the inventory system. This will be implemented effective October 1, 2023. Nan Nelson, SVP Region Chief Financial Officer, is responsible for this Corrective Action Plan.
Finding 2022-001 Activities Allowed or Unallowed and Allowable Costs/Cost Principles A material weakness in internal control over compliance was issued related to activities allowed or unallowed and allowable costs/cost principles for the R&D Cluster grant agreements of Advocate Aurora Health (the ...
Finding 2022-001 Activities Allowed or Unallowed and Allowable Costs/Cost Principles A material weakness in internal control over compliance was issued related to activities allowed or unallowed and allowable costs/cost principles for the R&D Cluster grant agreements of Advocate Aurora Health (the Organization). Charges of salaries and wages to the R&D Cluster were not consistently reviewed by a knowledgeable individual or not certified timely. In addition, certain individuals? effort certification did not account for 100% of their effort (R&D and institutional). This is a repeat finding (2021-002). The Office of Sponsored Research (OSR) committed in the 2020 Corrective Action Plan to implement a paper format effort certification process beginning March 2022. This process was fully implemented by the end of fiscal 2022. Also in 2022, Advocate Aurora Research Institute employees were transferred and integrated under one financial system. The integration of this system supports the monitoring of 100% of total effort. The OSR will also continue to utilize a paper effort certification process. The OSR team will generate effort certification form, distribute the effort certification form to the appropriate team member for manual or electronic signature and obtain a secondary approval signature from an individual who has first-hand knowledge of the team member's activities. All completed effort certification forms will be verified and initialed by a third individual. Effort certification logs will be maintained to ensure that all effort certifications are completed within 30 days. Completed effort certification forms will be maintained within OSR. Sarah Long, Director Sponsored Research, is responsible for this Corrective Action Plan.
Program: Airport Improvement Program Compliance: N ? Special Tests and Provisions Finding Type: Compliance and Internal Control Agency: Department of Transportation (DOT)/Federal Aviation Administration (FAA) Internal Control Impact: Significant Deficiency Finding: The City utilizes 745,190 square f...
Program: Airport Improvement Program Compliance: N ? Special Tests and Provisions Finding Type: Compliance and Internal Control Agency: Department of Transportation (DOT)/Federal Aviation Administration (FAA) Internal Control Impact: Significant Deficiency Finding: The City utilizes 745,190 square feet of land owned by the Aviation Department for the City?s Fire Department and Police Station serving the north Kansas City community including the Kansas City airport. The City pays ground rent of $0.168 per square foot per year based on a rate study done in 2003. Status: Corrective action plan in progress Corrective Action Plan: Fair and reasonableness of the rental rate: Upon completion of the New Terminal the Department will undertake either a Land Use Survey or a Market Rate Study to determine if our leased property is competitively priced. The Aviation Department has placed in FY24 budget a placeholder for a Market Study contract. Person(s) Responsible for Implementation: Fred O?Neill, Aviation Department Fiscal Officer, Telephone: (816) 243-3201; Email: Fred_ONeill@kcmo.org Implementation Date: Fair and reasonableness of the rental rate will be reviewed upon completion of the new terminal.
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