2008-2009 Monitoring Form Updated 4-09
1
CDBG SUBRECIPIENT MONITORING REVIEW FORM
2008-2009 Fiscal Year
CDBG Subrecipient :
Person Completing Form :
Date :
On-site monitoring visit Conducted On:
Monitoring Letter Sent On:
Start & End Date of Project :
Type of Project (circle one) :
Public Service
Housing
Economic Dev
Slum / Blight Clearance
1. Which National Objective does this project meet (570.208)?
Benefit to Low-Moderate-Income Persons
Low/Mod Area Benefit
Limited Clientele Benefit
Low/Mod Housing Benefit
Job Creation or Retention
Aid in the Prevention or Elimination of Slums or Blight
On an Area Basis
On an Spot Basis
An Urgent Need
Needs having a Particular Urgency
1. Identify the anticipated goals of this project.
Proposed Scope of Service:
Number of People to be Served:
PART 1: GENERAL INFORMATION
PART 3: PROGRAM OVERVIEW
PART 2: National Objective and Eligibility
2008-2009 Monitoring Form Updated 4-09
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Other :
2. What were the actual measurable accomplishments of this project to date?
Actual Scope of Services:
Actual Number Served:
Other:
3. Did the project provide the full scope of services proposed? If not, please explain.
4. Who was your intended client group?
Did you serve that Group?
a. Yes
b. No
(explain):
5. Was your project on schedule? Explain reasons for any delays.
a. Yes
b. No
(explain):
6. Did the project operate with the approved CDBG budget?
a. Yes
b. No
(explain):
7. Did the project conform to any additional or special terms of the CDBG Contract?
a. Yes
(explain):
b. No
8. If employees worked on both CDBG eligible and non-CDBG eligible activities, were
appropriate time distribution records kept?
a. Yes
b. No (
explain
):
2008-2009 Monitoring Form Updated 4-09
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9. Did your agency contract out any of the work that was completed under this project (Rehab
Projects Only)?
a. Yes
b. No
If yes, please provide a list of the contractors used:
10. Did your agency use CDBG funds to secure supplies for the project?
a. Yes
b. No
If yes, explain your procurement procedures.
11. Does your agency maintain a client file?
a. Yes
b. No
If yes, please describe the type of information maintained.
If no, please explain why you do not keep a client file, or explain other record keeping methods
utilized by your agency.
12. Who serves as the Project Manager for this project?
.
13. Is the Project Manager familiar with the basic requirements established by HUD and the
grantee for the use of CDBG funds?
a. Yes
b. No (
Explain
):
14. Is the Project Manager located on-site and running the day-to-day operation of the
program ?
a. Yes
b. No (
Explain
):
2008-2009 Monitoring Form Updated 4-09
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15. Do you feel this program accomplished what it was originally designed to accomplish?
a. Yes
b. No (
Explain
):
1. Explain how your agency records and tracks the use of CDBG funds.
2. Does your agency record encumbrances or obligations against CDBG funds when
contracts and purchase orders are executed?
a. Yes
b. No (
Explain
):
3. Are your accounting records supported by source documentation such as invoices,
contracts, and purchase orders?
a. Yes
b. No (
Explain
):
4. Has your agency requested reimbursement for CDBG expenses in excess of immediate
needs?
a. Yes (
Explain
):
b. No
5. Are there revenue accounts to support any program income generated through CDBG?
a. Yes (
Explain
):
b. No (
Explain
):
c. Not Applicable
6. What is the latest date of your agency's last audit?
*
* Agencies with budgets $500,000 or greater must provide a copy of their audit to the City.
Were any outstanding findings resolved?
a. Yes (
Explain
):
PART 4: REVIEW OF FINANCIAL RECORDS
2008-2009 Monitoring Form Updated 4-09
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b. No (
Explain
)
c. Not Applicable
If a government entity, does the audit comply with OMB Circular A-122?
Yes
No
If a nonprofit entity, does the audit comply with OMB Circular A-110?
Yes
No
1. Are record keeping requirements of the program being met?
a. Yes
b. No (
Explain
):
2. Did your agency submit its quarterly reports to the City in a timely manner?
a. Yes
b. No (
Explain
):
3. Does your agency maintain records that identify the following:
a. Income verification of clients
Yes
No
NA
b. Female headed household
Yes
No
NA
c. Race
Yes
No
NA
d. Ethnicity
Yes
No
NA
e. Disability Status
Yes
No
NA
f. Payroll / Timesheets
Yes
No
NA
g. Procurement
Yes
No
NA
h. Progress
Yes
No
NA
i. Other
Yes
No
NA
1. Please identify any areas related to CDBG where you would like technical assistance.
PART 5: RECORD KEEPING
PART 6: SUMMARY & FEEDBACK
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2. Please describe your agency's greatest successes and challenges this program year .
3. Please provide any additional feedback about your agency, the city, or your program
that you would like noted this program year .
Please identify the sources and actual amounts of other funding received in the last year to support
this CDBG project: (use back of sheet if necessary).
PART 7: LEVERAGE