Corrective Action Plans

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Michele B Sipley, Executive
Michele B Sipley, Executive
2024-001 Enrollment
2024-001 Enrollment
Reporting
Reporting
Director of Financial Aid; Kelly Campbell, University Registrar
Director of Financial Aid; Kelly Campbell, University Registrar
Uncorrected for FY25, as we have a repeat finding in the curent year
Uncorrected for FY25, as we have a repeat finding in the curent year
Condition: Management's review of the enrollment reporting did not detect that 2 student's change status was reported to NSLDS with incorrect information. Corrective Action Planned: The offices of Academic Advising and the Registrar will follow the procedure and process on student withdrawals and st...
Condition: Management's review of the enrollment reporting did not detect that 2 student's change status was reported to NSLDS with incorrect information. Corrective Action Planned: The offices of Academic Advising and the Registrar will follow the procedure and process on student withdrawals and student dismissals and inform the Senior Data Specialist and the Office of Financial Aid to ensure the date of withdrawal or date of dismissal is accurately and consistently recorded according to Alverno policy and to the National Student Loan Data System (NSLDS). Name(s) of Contact Person(s) Responsible for Corrective Action: Kate Tisch, Director -Academic Advising, Jillian Smith, Registrar, Denise Sanders, Senior Data Specialist and Naomi Coe, Director of Financial Aid. Anticipated Completion Date: This corrective action has been established and review of student changes of status are reviewed and reported on timely basis and accurately immediately.
Findings and Questioned Costs Relating to Federal Awards: Late Filing Report To address this issue, the Department will strengthen its administrative and management control processes to ensure accurate preparation and timely submission of all federal reports. The following corrective actions will be...
Findings and Questioned Costs Relating to Federal Awards: Late Filing Report To address this issue, the Department will strengthen its administrative and management control processes to ensure accurate preparation and timely submission of all federal reports. The following corrective actions will be implemented: 1. Establish Internal Reporting Calendar: The Department will implement a centralized reporting calendar that includes all federal reporting deadlines related to all Federal Funds managed by the Department including, the Coronavirus State and Local Fiscal Recovery Funds to ensure adequate time for preparation and review. 2. Assign Reporting Responsibility: A designated staff member will be responsible for monitoring federal reporting requirements and deadlines and coordinating report preparation and submission. 3. Review and Approval Process: Management will implement an internal review and approval process prior to report submission to ensure accuracy and completeness. 4. Monitoring and Oversight: Department management will periodically monitor compliance with reporting deadlines to ensure reports are submitted accurately and on time.
Findings and Questioned Costs Relating to Federal Awards: Insufficient Controls Related to the Application of Indirect Cost Rates The Department will strengthen its administrative and management control processes to ensure accurate preparation and calculation for the Indirect Cost. The following cor...
Findings and Questioned Costs Relating to Federal Awards: Insufficient Controls Related to the Application of Indirect Cost Rates The Department will strengthen its administrative and management control processes to ensure accurate preparation and calculation for the Indirect Cost. The following corrective actions will be implemented: 1. Establish Internal Review Process: The Department will implement an excel report that includes all Grants to ensure adequate calculation and review. 2. Assign Reporting Responsibility: A designated staff member will be responsible for monitoring federal reporting requirements according to NICRA limitations. 3. Review and Approval Process: Management will implement an internal review and approval process prior to report submission to ensure accuracy and completeness.
Findings and Questioned Costs Relating to Federal Awards: Eligibility of Individuals, Allowable Costs DDEC is implementing a series of corrective actions to ensure full compliance with WIOA eligibility documentation requirements, internal controls, and participant file management. The primary correc...
Findings and Questioned Costs Relating to Federal Awards: Eligibility of Individuals, Allowable Costs DDEC is implementing a series of corrective actions to ensure full compliance with WIOA eligibility documentation requirements, internal controls, and participant file management. The primary corrective strategy is the establishment of the PRIS system as the official digital participant file, combined with strengthened internal controls, mandatory documentation requirements, system validations, staff training, and ongoing monitoring. These corrective actions are designed to ensure that: • Eligibility documentation is completed and verified before services are provided. • Costs are only charged to WIOA programs for eligible participants. • Internal controls comply with 2 CFR 200 requirements. • Monitoring and validation processes ensure long-term compliance and sustainability. 1.Official Digital Participant File (PRIS) DDEC will designate the PRIS system as the official participant file repository for all WIOA programs. Services may not be recorded, and costs may not be charged unless the participant’s digital file contains complete eligibility documentation and a signed eligibility certification. Key Actions: • Issue formal directive establishing PRIS as the official file system. • Update operational manuals and program guidance. • Notify all subrecipients of implementation requirements. 2. Required Eligibility Documentation Controls DDEC will require that all eligibility documentation be uploaded to PRIS before participant activation or service entry. Required documentation includes proof of age, work authorization or citizenship, Selective Service registration (if applicable), proof of residence (if applicable), and signed eligibility certification. Key Actions: • Establish mandatory documentation checklist by participant type. • Require digital upload of all eligibility documentation. • Establish document quality and digital format standards. 3. PRIS System Controls and Validations DDEC will implement system controls within PRIS to prevent the entry of services or costs for participants with incomplete eligibility documentation. Key Actions: • Configure required fields for eligibility documentation. • Develop exception reports for incomplete participant files. • Pilot system controls with one subrecipient prior to full implementation. 4. Internal Controls and Monitoring DDEC will strengthen internal controls to ensure that eligibility documentation is verified prior to service delivery and cost charging. Key Actions: • Monthly PRIS exception reports identifying incomplete files. • Required correction within established timeframe. • Suspension of services or payments for non-compliant files. • Integration of digital file review into monitoring visits. • Standardized eligibility checklist for all subrecipients. 5. Training and Technical Assistance DDEC will provide training to subrecipients and internal staff on WIOA eligibility requirements, documentation standards, PRIS usage, and federal compliance requirements under Uniform Guidance (2 CFR 200). Training Topics: • WIOA eligibility requirements • Acceptable documentation • PRIS document upload procedures • Allowable costs and federal compliance • Internal control responsibilities 6. Ongoing Monitoring and Compliance Validation DDEC will implement quarterly compliance validation through sampling of participant files in PRIS to ensure documentation completeness and sustained compliance. Monitoring Measures: • Quarterly file sampling by subrecipient • Documentation completeness verification • Corrective action plans for subrecipients with deficiencies • Escalation procedures for repeated non-compliance • Annual compliance review after full implementation
Findings and Questioned Costs Relating to Federal Awards: Inadequate Internal Controls Over Compliance Related to Identification and Reporting of Assistance Listing Numbers (ALNs) in Schedule of Expenditures of Federal Awards To address this matter, management will implement the following corrective...
Findings and Questioned Costs Relating to Federal Awards: Inadequate Internal Controls Over Compliance Related to Identification and Reporting of Assistance Listing Numbers (ALNs) in Schedule of Expenditures of Federal Awards To address this matter, management will implement the following corrective actions: • Procedures will be implemented to ensure that Federal awards are properly identified and documented by Assistance Listing Number (ALN) upon receipt. • A centralized grant tracking schedule will be maintained to link expenditure to the appropriate ALN. • A supervisory review process will be established over the preparation of the Schedule of Expenditures of Federal Awards (SEFA) to verify the accuracy of ALN classifications prior to submission.
Finding Number: 2025‐001 Program Name/Assistance Listing Title: Water Conservation Grant Assistance Listing Number: 21.027 Contact Person: Brianne Ford, Business Manager Anticipated Completion Date: April 6, 2026 Planned Corrective Action: The District has designed and implemented policies and proce...
Finding Number: 2025‐001 Program Name/Assistance Listing Title: Water Conservation Grant Assistance Listing Number: 21.027 Contact Person: Brianne Ford, Business Manager Anticipated Completion Date: April 6, 2026 Planned Corrective Action: The District has designed and implemented policies and procedures over procurement, specifically suspension and debarment, to ensure goods and services are procured through vendors who are not suspended or debarred, so that federal monies exceeding the formal procurement threshold are used appropriately. The Federal Programs Director and Procurement Clerk will check each vendor exceeding the formal procurement threshold for suspension or debarment.
Name of Contact Person: Kristy Christenberry, Interim Chief Finance Officer Corrective Action Plan: The Board of Education will implement controls and procedures to ensure that all bank account and other required reconciliations are prepared on a timely basis going forward. Proposed Completion Date:...
Name of Contact Person: Kristy Christenberry, Interim Chief Finance Officer Corrective Action Plan: The Board of Education will implement controls and procedures to ensure that all bank account and other required reconciliations are prepared on a timely basis going forward. Proposed Completion Date: Immediately
2025-003 Action Taken (Unaudited): Management will make the required deposits going forward. Anticipated completion date is June 30, 2026.
2025-003 Action Taken (Unaudited): Management will make the required deposits going forward. Anticipated completion date is June 30, 2026.
2025-002 Action Taken (Unaudited): Management is in the process of updating its control procedures to include proper written policies for the internal control over compliance of federal awards John Griffin, CFO of COF Training Services, Inc. (Management Agent of Integrated Living, Inc.) is responsib...
2025-002 Action Taken (Unaudited): Management is in the process of updating its control procedures to include proper written policies for the internal control over compliance of federal awards John Griffin, CFO of COF Training Services, Inc. (Management Agent of Integrated Living, Inc.) is responsible for this corrective action. Anticipated completion date is June 30, 2026.
The District will continue to seek opportunities to improve segregation of duties. The recent addition of a new staff member is expected to enhance internal controls.
The District will continue to seek opportunities to improve segregation of duties. The recent addition of a new staff member is expected to enhance internal controls.
Finding 2025-001: Reporting - ALN 93.243 Finding: For the budget period ended September 30, 2025, the FFR was required to be submitted by December 28, 2025; however, the Hospital did not submit the FFR until January 7, 2026, which was after the required due date. Contact Person: Anthony McWhorter, V...
Finding 2025-001: Reporting - ALN 93.243 Finding: For the budget period ended September 30, 2025, the FFR was required to be submitted by December 28, 2025; however, the Hospital did not submit the FFR until January 7, 2026, which was after the required due date. Contact Person: Anthony McWhorter, Vice President of Finance Corrective Action Planned: La Rabida Children's Hospital will implement procedures to ensure all required federal financial reports are prepared and finalized in advance of established due dates. Management will also perform periodic access reviews of federal reporting portals to confirm that appropriate personnel have timely access to submit required reports. Anticipated Completion Date: Implemented as of the fiscal year ended June 30, 2026.
2025-003 CERTIFIED PAYROLL REPORTING Federal Assistance Listing Number: 84.041 Program: Impact Aid Federal Agency: U.S. Department of Education Pass-Through Agency: N/A Grantor Number: N/A Questioned Costs: $-0- Compliance Requirement: N. Special Tests and Provisions Award Period: July 1, 2024 – Jun...
2025-003 CERTIFIED PAYROLL REPORTING Federal Assistance Listing Number: 84.041 Program: Impact Aid Federal Agency: U.S. Department of Education Pass-Through Agency: N/A Grantor Number: N/A Questioned Costs: $-0- Compliance Requirement: N. Special Tests and Provisions Award Period: July 1, 2024 – June 30, 2025 Type of Finding: Noncompliance (Other Matter), significant deficiency in internal control Repeat Finding: This is not a repeat finding. Condition/Context: The District did not retain documentation sufficient to determine the Davis- Bacon compliance clause was included in advertised specifications for construction projects paid with federal Impact Aid monies. In addition, for five of 5 vendors selected weekly certified payrolls were not collected and maintained for any relevant weeks during the fiscal year. Corrective Action: The District will review its policies and procedures certified payroll reporting in accordance with the Davis Bacon compliance and will ensure certified payroll reporting is completed on all appropriate minor construction projects. Planned completion date for corrective action plan: For the period ending June 30, 2026. Name of the contact person responsible for corrective action: Casey Hancock, Business Manager
Finding: 2025-001 CFDA #: 84.063 and 84.268 Recommendation: We recommend the College monitor and evaluate the schedule reporting dates to the NSLDS and confirm or modify existing policies, procedures, or processes from timely identification to ensure that status changes can be communicated to the NS...
Finding: 2025-001 CFDA #: 84.063 and 84.268 Recommendation: We recommend the College monitor and evaluate the schedule reporting dates to the NSLDS and confirm or modify existing policies, procedures, or processes from timely identification to ensure that status changes can be communicated to the NSLDS within the regulatory timeframes. Explanation of disagreement with audit finding: There is no disagreement with the audit finding Corrective Action Plan: All graduate and withdrawn student files will be reviewed on a monthly basis to verify any status changes are reported to NSLDS within regulatory timeframes. Training and professional development will be required for responsible staff to ensure a compliance schedule is developed. Personnel will be evaluated to ensure existing policies, procedures, and processes are followed and supported through corrective action where needed. Name of Contact Responsible for Corrective Action: Joy Hirdler, Vice President of Financial Administration, Chief Financial Officer, 707-965-6699 Anticipated Completion Date: March 31, 2026
NPS will enhance its system of internal controls by implementing a standardized, enterprise-level review and approval process for all National School Lunch Program (NSLP) and Fresh Fruit and Vegetable Program (FFVP) reimbursement reports. Effective immediately, all claims for reimbursement will requ...
NPS will enhance its system of internal controls by implementing a standardized, enterprise-level review and approval process for all National School Lunch Program (NSLP) and Fresh Fruit and Vegetable Program (FFVP) reimbursement reports. Effective immediately, all claims for reimbursement will require documented supervisory review and formal approval prior to submission, ensuring accuracy, completeness, and full compliance with federal and program requirements. Related policies and procedures will be revised to clearly define accountability, documentation standards, and submission timelines. In parallel, NPS will invest in targeted training for all personnel involved in the preparation and certification of claims to ensure consistent execution of these requirements. To sustain compliance and reinforce accountability, we will establish a structured monitoring framework that includes periodic, risk-based reviews of submitted claims and supporting documentation. This approach will provide ongoing assurance that all claims are properly reviewed, approved, and supported in accordance with established standards.
NPS will strengthen its timekeeping and payroll control environment by implementing a standardized, no-exception requirement that all timesheets are reviewed and formally approved by supervisors prior to payroll processing. Documented evidence of approval will be maintained to ensure a complete and ...
NPS will strengthen its timekeeping and payroll control environment by implementing a standardized, no-exception requirement that all timesheets are reviewed and formally approved by supervisors prior to payroll processing. Documented evidence of approval will be maintained to ensure a complete and auditable record. Policies and procedures will be updated to clearly define roles, responsibilities, documentation standards, and retention requirements, ensuring alignment with 2 CFR 200.303 and reinforcing accountability across the organization. To support consistent execution, NPS will require mandatory training for all employees and supervisors involved in time and effort reporting, with an emphasis on accuracy, compliance, and the connection to federal cost allowability. In addition, NPS will implement a structured monitoring process that includes periodic, risk-based reviews of timesheets and payroll transactions to identify and address any control gaps.
Research and Development – Assistance Listing No. 11.000 Research and Development – Assistance Listing No. 11.617 Research and Development – Assistance Listing No. 12.000 Research and Development – Assistance Listing No. 20.000 Research and Development – Assistance Listing No. 20.109 Research and De...
Research and Development – Assistance Listing No. 11.000 Research and Development – Assistance Listing No. 11.617 Research and Development – Assistance Listing No. 12.000 Research and Development – Assistance Listing No. 20.000 Research and Development – Assistance Listing No. 20.109 Research and Development – Assistance Listing No. 43.000 Research and Development – Assistance Listing No. 43.001 Research and Development – Assistance Listing No. 43.002 Research and Development – Assistance Listing No. 43.008 Research and Development – Assistance Listing No. 43.012 Research and Development – Assistance Listing No. 47.083 Research and Development – Assistance Listing No. 81.000 Economic Development Cluster - Assistance Listing No. 11.307 Recommendation: We recommend OSU should notify the applicable sponsors and federal agencies regarding the calculated questioned costs and make any necessary repayments or adjustments. Further, OSU should develop and document a process to ensure the PES rates are developed and billed in accordance with OSU Policy, applicable federal regulations, and the requirements of OSU’s Federal Agreements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: OSU will notify the applicable sponsors and federal agencies to resolve the questioned costs. OSU will also develop a process to ensure the correct PES rates are calculated and billed. Name(s) of the contact person(s) responsible for corrective action: Chris Kuwitzky, Senior Vice President for Administration & Finance and Chief Financial/Administrative Officer and Kenneth Sewell, Vice President for Research Planned completion date for corrective action plan: September 30, 2026
Research and Development – Assistance Listing No. 20.000 Coronavirus State and Local Fiscal Recovery Funds - Assistance Listing No. 21.027 Recommendation: We recommend that OSU STW and OSU CHS review policies and procedures for procurement to ensure that every applicable transaction is going through...
Research and Development – Assistance Listing No. 20.000 Coronavirus State and Local Fiscal Recovery Funds - Assistance Listing No. 21.027 Recommendation: We recommend that OSU STW and OSU CHS review policies and procedures for procurement to ensure that every applicable transaction is going through the proper procurement procedures. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: OSU STW: The cause of this issue was primarily due to time constraints associated with completing work, which led to procurement procedures not being followed and purchases being initiated prior to obtaining proper authorization. To address this issue, the organization requires completion of a Ratification of Unauthorized Commitment form for all instances where proper procurement procedures were not followed. These instances are tracked and monitored by the Procurement Office. In addition, personnel have been re-educated on procurement requirements, with specific emphasis that a PO must be in place and approved prior to the initiation of work or commitment of funds. OSU CHS will reinforce existing procurement policies and procedures for federally funded purchases. Management will provide targeted communication and training to departments to ensure that applicable procurement requirements (such as obtaining competitive quotes or sole source justification) are followed when purchases exceed established thresholds. This communication will emphasize that total expected cost, including shipping and handling when known, must be considered when determining the appropriate procurement method. Name(s) of the contact person(s) responsible for corrective action: OSU-STW Jorge Guerrero, Norb Delatte, Jean Kerr-Hunter. OSU-CHS Michael Sauer Planned completion date for corrective action plan: OSU-STW Completed April 30, 2024, OSU-CHS May 31, 2026
Research and Development – Assistance Listing No. 93.859 Recommendation: We recommend that OSU CHS implement and consistently perform procedures to ensure that all equipment purchased with federal funds is subject to a physical inventory at least once every two years, with results properly documente...
Research and Development – Assistance Listing No. 93.859 Recommendation: We recommend that OSU CHS implement and consistently perform procedures to ensure that all equipment purchased with federal funds is subject to a physical inventory at least once every two years, with results properly documented and reconciled to equipment records. We further recommend that OSU CHS strengthen controls over tracking equipment locations to ensure that federally funded equipment can be readily identified and physically located when required. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: OSU CHS will reinforce existing procedures for tracking and monitoring equipment. Management will provide targeted communication and training to departments to ensure that federally funded equipment is properly identified, recorded, and included in required physical inventory processes. OSU CHS will emphasize departmental responsibility for maintaining accurate location information and ensuring equipment is readily identifiable during inventory activities. Name(s) of the contact person(s) responsible for corrective action: Michael Sauer, Director, OSU CHS Planned completion date for corrective action plan: May 31, 2026
Research and Development – Assistance Listing No. 11.469 Research and Development – Assistance Listing No. 20.000 Research and Development – Assistance Listing No. 47.083 Research and Development – Assistance Listing No. 81.089 Recommendation: We recommend the OSU STW review and update policies and ...
Research and Development – Assistance Listing No. 11.469 Research and Development – Assistance Listing No. 20.000 Research and Development – Assistance Listing No. 47.083 Research and Development – Assistance Listing No. 81.089 Recommendation: We recommend the OSU STW review and update policies and procedures to allow for more timely payment to subrecipients for work the University contracts them to perform. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The delays resulted from staffing shortages and turnover, as well as a misunderstanding of the Uniform Guidance requirements. To address this issue, information will be shared with departments regarding the importance of timely invoice processing. This communication will emphasize that invoices must be processed promptly, any discrepancies that could delay payment should be clearly noted on the invoice, and explanations for such discrepancies will be documented. To prevent recurrence, staff will receive additional guidance to ensure they fully understand the Uniform Guidance requirements related to subrecipient payments. Name(s) of the contact person(s) responsible for corrective action: Andrea Sherwood, Assistant Director of Grants and Contracts Financial Administration Planned completion date for corrective action plan: May 31, 2026
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