Level 4
Level 4
Approval Form
INTRODUCTION
There are five levels of approval under the new Ministry of Social Development (MSD) approval
system. Level 4 Approval may apply to any organisation who is contracted by MSD, including Family
and Community Services (FACS), Work and Income (W&I), Ministry of Youth Development (MYD),
Child, Youth and Family (CYF) and Students Seniors & Integrity Services (SSIS). Level 4 does not apply
to any organisation contracted to provide services that require approval under the Children,
Young Persons and their Families Act 1989.
The service(s) your organisation has been funded to provide requires a Level 4 Approval.
Completion of this form will enable the Ministry to assess your compliance with the Standards for
Level 4. The Standards for Approval Level 4 can be found in Appendix One at the end of this form.
INSTRUCTIONS
Please complete the information requested in this Level 4 Approval Form including:
• Organisation Details
• Self-Assessment
• Declaration.
Please ensure you answer each question representing the true position of your organisation at the time
of your assessment.
Attach any supporting information to this document. When you have completed all sections, please sign
and submit your application to the Team Leader Approvals for your region.
Use the appropriate address over the page, or as advised by the Ministry.
Review of compliance with the standards
The Ministry will require you to complete this process every two years when your review of compliance
with these standards is due. If you have previously provided supporting documentation that has not
been updated, please check with the Team Leader Approvals before resubmitting these documents.
Level 4 Approval Form
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Team Leader Approvals
Northern
North Auckland, Auckland, Counties Manukau, South Auckland, Northland
Postal address:
Private Bag 68 911
Newton
AUCKLAND 1145
Street address:
Building A
65 Main Highway
Ellerslie
AUCKLAND
Phone: 09 917 7204
Midlands
Whanganui, Taranaki, Central Plateau, Taupo, Bay of Plenty, Waikato, King Country, Coromandel
Postal address:
Private Bag 3222
Waikato Mail Centre
HAMILTON 3240
Street address:
Level 9, Anglesea Tower
Cnr. Collingwood and
Anglesea Street
HAMILTON
Phone: 07 957 1546
Central
Dannevirke, Pahiatua, Horowhenua, Tararua District, Wairarapa, Wellington, Chatham Island, Gisborne,
Hawke's Bay
Postal address:
PO Box 27 504
WELLINGTON 6141
Street address:
Level 1, Freemason House
195-201 Willis Street
WELLINGTON
Phone: 04 918 4689
Southern
Canterbury, Southland, Otago, Marlborough, Buller, West Coast, Nelson, Tasman
Postal address:
PO Box 940,
CHRISTCHURCH 8053
Street address:
Firestone Building
84 Langdons Road, Papanui
CHRISTCHURCH
Level 4 Approval Form
Phone: 03 961 4336
2
BEFORE YOU BEGIN
Do you already have Ministry of Social Development approval for Level 1, 2 or 3?
Yes
No
If you have answered yes to the above question, please do not proceed with this form. Contact your local Approval
Team to discuss whether any further information is required.
Have you also been approved for equivalent factors by another Government
Agency, such as NZQA, Ministry of Justice or Ministry of Education, and have
evidence of that approval?
Yes
No
If you have answered yes to the above question, only complete the Organisation Details section of this form and
submit with evidence of the other government agencies approval, together with the financial information required for
Standard 2.
You may not need to complete the full approval process. The Ministry Approvals Team will contact you if they require
further information.
Level 4 Approval Form
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ORGANISATION DETAILS
Your Organisation’s Details
Legal name of your organisation:
Other names commonly used by your organisation:
Main office street address
Number:
Street Name:
Suburb or RD No.:
Town or City:
Postcode:
Main office postal address
(if different from above)
Number:
Street Name:
Suburb or RD No.:
Town or City:
Postcode:
PO Box/Private Bag:
Town or City:
Postcode:
Key Contact Details
Contact person
and position held
Telephone number
Facsimile number
Name:
Position:
Business:
(0 )
Mobile:
(0
)
(0 )
Website:
Email address: What is the legal status of your organisation?
Charitable Trust
Organisation set up under statute
Incorporated Society
Partnership
Limited Liability Company
Unincorporated Body
Named individual
Registration number:
(if applicable)
Has there been any change to your organisations legal status?
Level 4 Approval Form
Yes
No
4
SELF-ASSESSMENT
The Guidance provided in the Standards may assist you to complete this section.
STANDARD 1
Organisational Structure/Legal Status
and Governance
The service provider has a verifiable and legitimate structure in place.
 The organisation
shall demonstrate to
the Ministry of Social
Development:
Criteria
1
Evidence of a legitimate operational structure that is both valid and current.
Demonstrate how you meet the standards and provide the following
evidence where relevant:
• Certificate of Incorporation and Trust Deed
• Description of legal identity, e.g. sole trader or limited
liability company.
Confirmation of identity is required if you are a sole trader e.g. passports
or driver's license, a description of how the business operates and evidence
of risk management planning.
Level 4 Approval Form
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2
Management structures are in place (which ensure the service is able to function and
operate effectively) that make clear the lines of accountability in relation to Governance1
issues (Board/management accountability), staffing issues, and the relationship the
provider has with its clients.
Demonstrate how you meet the standards and provide the following
evidence where relevant:
•
•
•
•
•
•
•
•
Constitution
Rules and Charters
Information on board/management
Organisational structure charts
Details of roles and responsibilities for the Board and management
Management/governance reports
Board meeting minutes
Employment agreements.
1 Governance refers to setting the parameters of the organisation, eg services to be provided, how the
organisation will be managed, and the roles and responsibilities of managers. A governing body usually
carries out this role. The management structure refers to the system of decision making within the
parameters set by the governing body.
Level 4 Approval Form
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STANDARD 2
Financial and Information Systems and Viability
Management information systems are in place, including adequate internal financial
controls that enable the organisation to report to a level that is commensurate with
the complexity and turnover of the operation, and that clearly show how the Ministry’s
money is spent annually.
 The organisation
shall demonstrate to
the Ministry of Social
Development:
Criteria
1
The on-going financial viability of the organisation.
Please attach a copy of:
• the most recent IRD statement for GST and PAYE purposes
• the most recent audited/reviewed accounts (unless agreed otherwise
with MSD)
• the last general meeting minutes and annual report
• interim financial statements and copies of recent bank statements
(if a new organisation)
• a plan to address any potential areas of concern regarding financial
viability.
2
Clear delegations are made for financial accountability ensuring the security of funds
and accounts.
Demonstrate how you meet the standards and provide evidence
where relevant:
•
•
•
•
Level 4 Approval Form
a list of financial delegations
levels of sign-off for expenditure and payments
responsibilities of those with financial delegations
any other appropriate internal controls.
7
3
Indemnity insurance is in place for the delivery of services and for Board members or
Directors, where necessary.
Demonstrate how you meet the standards and provide the following
evidence:
• a copy of professional, organisational and/or financial indemnity
insurance, including:
–– insurance policy held
–– value of policy
–– insurer's name
–– expiry date.
Level 4 Approval Form
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4
Information on other government funding being received.
Please provide evidence where relevant:
• a list of funding received from the Ministry or other government
agencies including the contract name, type of service and current term.
5
Secure storage of information.
Demonstrate how you meet the standards and provide evidence
where relevant:
• details of where staff and client information is stored.
Level 4 Approval Form
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STANDARD 3
Human Resource Practices
Staff recruitment policies and procedures are in place that reflect fair and equitable
employment practices, and meet all mandatory requirements in relation to the hiring,
employment and termination of all employees.
 The organisation
shall demonstrate to
the Ministry of Social
Development:
Criteria
1
Competency in managing employment relations, including compliance with statutory
requirements and mandatory Ministry requirements.
Demonstrate how you meet the standards and provide evidence
where relevant:
• Human Resource policies and procedures, including:
–– recruitment
–– induction
–– evidence of professional development and training
–– supervision
–– complaints process
–– harassment
–– equal employment opportunities
–– personal information.
Level 4 Approval Form
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2
That personnel are suitable (Criminal Conviction Checks).
Demonstrate how you meet the standards and provide evidence
where relevant.
All staff involved in the delivery of services or with access to funding paid by
the Ministry have been vetted.
Yes No (circle)
Level 4 Approval Form
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STANDARD 4
Capability to Deliver and Report
The organisation must have the capability to deliver services and report how
this is achieved.
 The organisation
shall demonstrate to
the Ministry of Social
Development:
Criteria
1
Systems are in place that enable the organisation to report on legislative or contract
obligations as and when required.
Demonstrate how you meet the standards and provide evidence
where relevant:
• a list of reporting requirements together with the required frequency
of reporting.
These reports may include examples of your contractual obligations:
• all appropriate information relative to clients
• statistical information on client numbers and demographics
• client attendance and participation in programmes and activities.
Does your organisation monitor this information to ensure accuracy and
consistency of reporting and ensure programmes are well planned?
Yes No (circle)
Provide examples if possible.
Level 4 Approval Form
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2
The organisation ensures that it meets all legal responsibilities when providing services.
Demonstrate how you meet the standards and provide evidence where
relevant, for example:
• policies and procedures including those for health and safety.
DECLARATION
I declare that:
a) all the details contained in this declaration are true and correct to the best of my knowledge and belief; and
b) that I have the authority of my organisation to sign this declaration and provide the required information.
Agree with declaration:
Name and position of
person making declaration:
Name:
Position:
Signature:
Level 4 Approval Form
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Level 4
APPENDIX ONE
Social Services
Standards for Approval
Introduction
As part of our quality assurance, the Ministry of Social Development produces
Standards for Approval which are designed to ensure that community
organisations seeking formal approval status from the Ministry have the
quality, management and administration of the services they provide, assessed
against consistent standards that meet legislative requirements.
Approval under these standards allows the
Ministry to consider funding approaches for
programmes or services, although the Ministry
will not necessarily negotiate or enter into
contracts simply because the organisation
is approved.
These Standards for Approval are produced by
the Ministry of Social Development (MSD) for
the approval of Level 4 Social Services.
The Standards for Approval
These standards cover four key areas:
• Organisational Structure/Legal Status
and Governance
• Financial and Information Systems
and Viability
• Human Resource Practices
• Capability to Deliver and Report.
Level 4 Approval Form | Standards for Approval
Guidance
The standards are produced with guidelines
which are designed to assist providers to
determine how they might demonstrate
compliance with the standards.
Organisations seeking approval will either
be provided with a Level 4 Approval Form by
Ministry staff or can access the form on the
Ministry's website www.msd.govt.nz
Level 4
Social Services
Standards for Approval
and Guidelines
APPROVAL STANDARD 1
Organisational Structure/Legal Status and Governance
The service provider has a verifiable and legitimate structure in place.
 The organisation
shall demonstrate to
the Ministry of Social
Development:
Criteria
1
Evidence of a legitimate operational structure that is both valid and current.
Guidance
Provide evidence of the type of entity or organisation through Certificates
of Incorporation or Trust Deeds, and supply any current and registered
amendments to the organisation’s founding document or Deed. In the
event of the provider being a sole trader, confirmation of identity (e.g. a
verified copy of a passport or drivers licence), a description of how the
business operates and evidence of risk management planning is required to
be provided.
Level 4 Approval Form | Approval Standard 1
1
2
Management structures are in place (which ensure the service is able to function and
operate effectively) that make clear the lines of accountability in relation to governance
issues (Board/management accountability), staffing issues, and the relationship the
provider has with its clients.
Guidance
Provide evidence of the structure of the organisation and Board/
management membership to demonstrate compliance with statutory
minimum requirements.
Information that should be provided includes:
•
•
•
•
•
organisational structure diagrams
board/management roles and responsibilities
board/management recruitment process
board/management member profiles, including skills and qualifications
minutes of Annual General Meetings, board meetings, reports to board.
Summarise and provide evidence of the governance and management
processes and systems, and lines of accountability between the Board and
management (also see Standard 1, number 1)1. Evidence may include:
•
•
•
•
management/governance reports
management/governance meeting minutes
employment agreements
documents provided for Standard 1, number 1.
1 Governance refers to setting the parameters of the organisation, e.g. services to be provided, how
the organisation will be managed, and the roles and responsibilities of managers. A governing body
usually carries out this role. The management structure refers to the system of decision making within
the parameters set by the governing body.
Level 4 Approval Form | Approval Standard 1
2
STANDARD 2
Financial and Information Systems and Viability
Management information systems are in place, including adequate internal financial
controls, that enable the organisation to report to a level that is commensurate with
the complexity and turnover of the operation and that clearly shows how the Ministry’s
money is spent annually.
 The organisation
must be able to
demonstrate to
the Ministry of Social
Development:
Criteria
1
The on-going financial viability of the organisation.
Guidance
Provide a recent set of annual accounts that show a statement of financial
position and a statement of financial performance. These should show that:
• the organisation is solvent (assets minus liabilities)
• positive equity
• positive working capital
• stable financial performance/position over time.
These accounts must be independently compiled and audited or reviewed
(unless express exception is given in writing by the Ministry), and copies
of the auditor’s reports or review statements should be provided. If an
organisation has only recently been established and does not have any
annual accounts, provide interim financial statements and copies of recent
bank statements to provide evidence of solvency. If there are any potential
areas of concern regarding financial viability, provide a plan to address the
financial situation.
2
Clear delegations are made for financial accountability ensuring the security of
funds and accounts.
Guidance
A list of delegations, levels, responsibilities and duties.
Level 4 Approval Form | Approval Standard 2
3
3
Indemnity insurance is in place for the delivery of services and for Board members or
Directors, where necessary.
Guidance
Organisations will be able to provide details of indemnity insurance,
including policies held, the value, the insurers name and the expiry date
of the policy.
4
Information on other government funding being received.
Guidance
Provide a list of funding being received from the Ministry or other
Government agencies including the name of the contract, type of service
and current term.
5
Secure storage of information.
Guidance
Describe how and where information is stored – in particular all information
regarding clients and Ministry contracts. This information must be securely
held and in compliance with the Privacy Act 1993.
Level 4 Approval Form | Approval Standard 2
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STANDARD 3
Human Resource Practices
Staff recruitment policies and procedures are in place that reflect fair and equitable
employment practices, and meet all mandatory requirements in relation to the hiring,
employment and termination of all employees.
 The organisation
must be able to
demonstrate to
the Ministry of Social
Development:
Criteria
1
Competency in managing employment relations, including compliance with statutory
requirements and mandatory Ministry requirements.
Guidance
Organisations will have written Human Resource (HR) policies and
procedures in place which align with and refer to relevant legislation.
Relevant legislation may include Employment Relations Act 2000, Minimum
Wage Act 1983, Holidays Act 2003, Health and Safety in Employment Act
1992 and Amendments Act 2002, Human Rights Act 1993.
Policies and procedures should cover recruitment, induction, professional
development and training, support/supervision, complaints processes,
harassment, EEO and appropriate storage, collection, disclosure and use
of personal information in accordance with the Privacy Act 1993.
2
That personnel are suitable (Criminal Conviction Checks).
Guidance
All contracted social service providers must complete Criminal Conviction
Checks of staff involved in the delivery of services or with access to funding
paid by the Ministry.
Level 4 Approval Form | Approval Standard 3
5
STANDARD 4
Capability to Deliver and Report
The organisation must have the capability to deliver services and report how this
is achieved.
 The organisation
must be able to
demonstrate to
the Ministry of Social
Development:
Criteria
1
Systems are in place that enable the organisation to report on legislative or contract
obligations as and when required.
Guidance
The organisation must have robust processes in place to allow for accurate
capturing and reporting on information required under contract obligations
and legislation, including but not limited to:
• all appropriate personal information relating to the client and organisation
• statistical information on client numbers and demographics
• client attendance and participation in programmes and activities.
There should be internal monitoring/auditing to ensure accuracy, and
consistency and service planning processes. Programmes provision should
be evaluated and changes made where necessary.
2
The organisation ensures that it meets all legal responsibilities when providing services.
Guidance
The organisation must meet its legal responsibilities in respect to the Health
and Safety in Employment Act 1992, and any other relevant legislation,
when providing programmes and services to clients.
Storage, collection, disclosure and use of personal information should
comply with the Privacy Act 1993.
Level 4 Approval Form | Approval Standard 4
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