Form SFN60470 "Esg/Ndhg Monitoring Report and Guidelines" - North Dakota

What Is Form SFN60470?

This is a legal form that was released by the North Dakota Department of Commerce - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the North Dakota Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60470 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Commerce.

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ESG/NDHG MONITORING REPORT AND GUIDELINES
NORTH DAKOTA DEPARTMENT OF COMMERCE
DIVISION OF COMMUNITY SERVICES
SFN 60470 (07/18)
General Information
Grantee
Contact Person
Title
Address
City
State
ZIP Code
Grant Number(s)
Grant Amount
Monitoring Date
Grantee Performance, Program Management, and Fair Housing
1. Was the grant utilized as proposed in the grantee’s application? (review program description &
Yes
No
grant application)
2. Were there any amendments to the grant? If yes, for what?
Yes
No
3. Does the agency have a grievance procedure for clients?
Yes
No
4. Does the agency have written position descriptions for staff administering this program?
Yes
No
5. Does the grantee have a fully accessible (i.e., barrier-free) site available for persons to apply
Yes
No
for program benefits? If not, what accommodations are made available?
6. Is your agency currently participating in the HMIS?
Yes
No
7. For projects serving domestic violence victims, is there established written procedures
regarding confidentiality of client records and the address/location of any project serving
Yes
No
domestic violence victims?
8. Does the grantee have a written policy for the termination of clients?
If no written guidance is available, interview staff to determine how terminations are handled.
Describe:
Yes
No
9. Has the grantee posted all required notices relative to Equal Employment Opportunity and
Yes
No
Fair Housing?
10. Does the grantee maintain and update a list of Fair Housing Resources?
Yes
No
11. Does the grantee use the Fair Housing logo on all materials relating to their housing programs
Yes
No
distributed to the general public?
12. Who is the Fair Housing contact person?
13. Has the program received any discrimination complaints?
Yes
No
ESG/NDHG MONITORING REPORT AND GUIDELINES
NORTH DAKOTA DEPARTMENT OF COMMERCE
DIVISION OF COMMUNITY SERVICES
SFN 60470 (07/18)
General Information
Grantee
Contact Person
Title
Address
City
State
ZIP Code
Grant Number(s)
Grant Amount
Monitoring Date
Grantee Performance, Program Management, and Fair Housing
1. Was the grant utilized as proposed in the grantee’s application? (review program description &
Yes
No
grant application)
2. Were there any amendments to the grant? If yes, for what?
Yes
No
3. Does the agency have a grievance procedure for clients?
Yes
No
4. Does the agency have written position descriptions for staff administering this program?
Yes
No
5. Does the grantee have a fully accessible (i.e., barrier-free) site available for persons to apply
Yes
No
for program benefits? If not, what accommodations are made available?
6. Is your agency currently participating in the HMIS?
Yes
No
7. For projects serving domestic violence victims, is there established written procedures
regarding confidentiality of client records and the address/location of any project serving
Yes
No
domestic violence victims?
8. Does the grantee have a written policy for the termination of clients?
If no written guidance is available, interview staff to determine how terminations are handled.
Describe:
Yes
No
9. Has the grantee posted all required notices relative to Equal Employment Opportunity and
Yes
No
Fair Housing?
10. Does the grantee maintain and update a list of Fair Housing Resources?
Yes
No
11. Does the grantee use the Fair Housing logo on all materials relating to their housing programs
Yes
No
distributed to the general public?
12. Who is the Fair Housing contact person?
13. Has the program received any discrimination complaints?
Yes
No
SFN 60470 (07/18)
Page 2 of 6
Financial Management and Internal Accounting Control Monitoring
1. What is your fiscal year?
Jan 01 - Dec 31
June 01 - May 31
July 01 - June 30
Oct 01 - Sept 30
Other
2. Are financial and related records maintained per program requirements after closeout of your
Yes
No
grant? (DCS 5 years)
3. Who is responsible for generating/maintaining financial statements & records?
Director
Bookkeeper-Accountant
Outside Accounting Firm
CPA
Other (employs a staff person who possesses a bachelor’s degree in account, or
possesses experience in accounting along with college account credits, or a bookkeeper
whose work is overseen by an accounting firm)
4. Is supporting documentation maintained for all financial transactions?
Yes
No
5. How often are financial reports prepared?
Monthly
Quarterly
Annually
6. How often does the Board review financial statement and report?
Monthly
Quarterly
Annually
7. Are receipts issued for all cash contributions received?
Yes
No
8. Are bank reconciliations performed monthly?
Yes
No
9. Are there procedures for approving payments/cash to vendors?
Yes
No
10. What is the specified dollar amount required for Board approval?
11. Who is responsible for writing checks and paying bills?
12. Is more than one signature required for any check?
Yes
No
13. Does the Board authorize all bank accounts and check signers annually?
Yes
No
14. List Authorized Signatory(ies), by Title (there may be two or more signers)
15. Are checks signed only when accompanied by approved invoices?
Yes
No
16. Are the following insurance coverages currently in force?
Public Liability
Property
Worker’s Compensation
17. For staff salaries through ESG/NDHG funds, are you able to document that they work
Yes
No
exclusively with homeless and/or near homeless clients?
18. Does the organization maintain records of the hours worked for each volunteer by type of job?
Yes
No
SFN 60470 (07/18)
Page 3 of 6
For Shelter Facilities Only
1. If applicable, are the following licenses current? (provide documentation)
Certificate of Occupancy
Permit for Fire Marshall
Food Preparation
Programmatic Licensure (e.g., Substance Abuse, Day Care, etc.)
2.
Does the agency have written confidentiality procedures which cover?
Yes
No
Locking/security of files
Written authorization of release of information
3. Do clients have a secure place to store personal belongings and documents?
Yes
No
4. Is there at least one homeless person or formerly homeless participating in the policy
Yes
No
decision-making process regarding projects receiving funds?
5. Is the facility in compliance with all codes, general ordinances and laws zoning health
Yes
No
department compliance, etc.?
a. Are there any unresolved issues?
Yes
No
6. Is there regular pest control services?
Yes
No
If yes, how often?
7. Is there a regular garbage removal and adequate storage (such as a dumpster with a lid)?
Yes
No
8. Are the housekeeping and maintenance plans adequate to assure that the facility is clean and
Yes
No
in good repair?
9. Are clean linens provided for each client with a procedure to sanitize all linens and sleeping
Yes
No
surfaces?
10. Is there a crib, bed or mat with clean linen for each person?
Yes
No
11. Are fire drills conducted regularly, depending on the maximum length of stay?
Yes
No
How often?
12. Are fire detection systems operating, and are they tested regularly?
Yes
No
How often?
13. Are first aid equipment and supplies available at all times?
Yes
No
14. Is there adequate ventilation (i.e., bath-one operable window or fan; sleeping rooms-one
Yes
No
operable window designed to open)?
15. Are food service areas adequate and sanitary?
Yes
No
16. Are interior and exterior lighting adequate?
Yes
No
17. Are entrances and exits clear of debris, ice and other hazards?
Yes
No
18. Do clients have sufficient shower/bath basins and toilets in proper operating conditions?
Yes
No
SFN 60470
(07/18) Page 4 of 6
Exit Interview
The monitoring is completed by an exit meeting with the appropriate staff or representative(s) to discuss the
preliminary results of the monitoring visit and indicate that the grantee is to be formally informed of monitoring
findings identified to date and any follow-up actions required of the grantee.
Notes for Exit Interview
Estimated date for providing written monitoring report to grantee
What unanticipated problems or barriers have arisen throughout the implementation of the grant program?
Does the grantee need additional technical assistance to resolve these barriers?
Yes
No
Explain:
How can DCS be of more assistance to the grantee?
General Comments:
SFN 60470 (07/18)
Page 5 of 6
Monitoring Documentation Checklist
Name of Agency
Name of Tenant
Date
Eligibility Requirements
YES
NO
COMMENT
Proof of Identification
At Risk of Homelessness Certification
Release of Information
Screening Assessment of HMIS Printout
Income Documentation (pay stubs, etc.)
Self-Certification
Homeless Certification
Housing Requirements
YES
NO
COMMENT
Verification of Income
Intake & Assessment
Progress Notes
Utility Shut Off Notice (if applicable)
Documentation of Eviction (if applicable)
Lease/Rental Agreement
Housing Plan (for re-housing and prevention)
Rent Reasonableness (for re-housing and
prevention)
Habitability Standards Inspection Form
Lead-Based Paint Inspection Form
Page of 6