INDEPENDENT AUDITOR’S REPORT ON APPLYING AGREED-UPON
PROCEDURES
[DATE]
The Honorable Beth A. Wood, CPA, State Auditor
Office of the State Auditor
2 South Salisbury Street
20601 Mail Service Center
Raleigh, North Carolina 27699-0601
Dear Ms. Wood:
We have performed the procedures enumerated below, which were explained to us in the Letter
of Instruction to Component Auditors Testing the Eligibility Intake Functions for Certain
Federal Programs at County Governments and Health Districts dated May 29, 2015, solely to
assist you in evaluating the eligibility intake functions at [NAME OF AUDITED ENTITY] for
the year ended June 30, 2015. [NAME OF AUDITED ENTITY]’s management is responsible
for the eligibility intake functions. This agreed-upon procedures engagement was conducted in
accordance with attestation standards established by the American Institute of Certified Public
Accountants; the standards applicable to attestation engagements contained in Government
Auditing Standards, issued by the Comptroller General of the United States; and OMB Circular
A-133, Audits of States, Local Governments, and Non-Profit Organizations. The sufficiency of
these procedures is solely the responsibility of those parties specified in this report.
Consequently, we make no representation regarding the sufficiency of the procedures described
below either for the purpose for which this report has been requested or for any other purpose.
Summary of Procedures and Results

Obtain an understanding of internal controls, assess risk, and test internal controls over
the eligibility intake functions as required by OMB Circular A-133 §___.500(c).
Results: Please include a summary of procedures performed and results for each
program audited below. A reference may be made to the submitted turnaround document
with attached error documentation for known errors. Delete unnecessary lines.
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
Temporary Assistance for Needy Families (TANF)
Adoption Assistance – Title IV-E
Children’s Health Insurance Program (CHIP)
Medicaid

Determine whether required eligibility determinations/redeterminations were performed
(including obtaining any required documentation/verifications), that individual program
participants were determined to be eligible, and that only eligible individuals participated
in the program by selecting and performing tests on a sample from the population of all
individuals receiving benefits during the entire fiscal year. These tests should exclude
determinations based on Modified Adjusted Gross Income (MAGI-based determination)
for the Medicaid and Children’s Health Insurance Programs.
Results: Please include a summary of procedures performed and results for each
program audited below. A reference may be made to the submitted turnaround document
with attached error documentation for known errors. Delete unnecessary lines.
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
Temporary Assistance for Needy Families (TANF)
Adoption Assistance – Title IV-E
Children’s Health Insurance Program (CHIP)
Medicaid

Determine whether amounts provided to or on behalf of eligibles were calculated in
accordance with program requirements.
Results: Please include a summary of procedures performed and results for each
program audited below. A reference may be made to the submitted turnaround document
with attached error documentation for known errors. Delete unnecessary lines.
Special Supplemental Nutrition Program for Women Infants and Children (WIC)
Temporary Assistance for Needy Families (TANF)
We were not engaged to and did not conduct an examination, the objective of which would be
the expression of an opinion on eligibility intake function of [NAME OF AUDITED ENTITY].
Accordingly, we do not express such an opinion. Had we performed additional procedures, other
matters might have come to our attention that would have been reported to you.
In accordance with Government Auditing Standards, we reported significant deficiencies,
material weaknesses, instances of fraud, noncompliance with provisions of laws, regulations,
contracts, or grant agreements, or abuse that have a material effect on the eligibility intake
function that warrant the attention of those charged with governance to [NAME OF AUDITED
ENTITY] officials. This paragraph should be modified or removed depending on the
circumstances and findings of your audit.
This report is intended solely for the information and use of the Office of the State Auditor and
management of [NAME OF AUDITED ENTITY] and is not intended to be and should not be
used by anyone other than these specified parties.
Sincerely,
_____________________________________
(Signature of Component Audit Firm Partner)