Community Assistance (CA)
Community Development Block Grant
Grantee:
Prepared by:
Telephone number:
Grant Number:
Date Prepared:
Email Address:
Project Name: _________________________________________________________________________
1.
Authorization to Incur Costs
Has the governing body adopted a project or budget ordinance? If yes indicate type of ordinance adopted and date adopted.
Yes No
What is the date for release of funds?
What date were the Funding Approval and Grant
Agreement Signed by Director of CA?
2.
Type of Activity
Exempt (administration
& planning)
Non-Exempt (hard costs)
Release Date
Has the grantee obligated funds prior to the allowable dates? If yes, list items below:
Vendor or Contractor Date
Date of Obligation
Yes No
Amount
3.
Source Documentation
Activity
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4.
Community Assistance (CA)
Community Development Block Grant
Grantee Financial System
Do the requisitions represent advance payments or reimbursements? If the grantee is on advance payments complete the chart below:
Requisition Number:
Total Amount:
Date of EFT:
Date Check # Amount
Advance
Reimbursements
Vendor
Days Between
Deposit and
Disbursement
Total:
Requisition Number:
Total Amount:
Date of EFT:
Date Check # Amount Vendor
Days Between
Deposit and
Disbursement
5.
Total:
Was there a violation of the 3-day rule?
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6.
7.
Community Assistance (CA)
Community Development Block Grant
Is the depository for CDBG funds interest- bearing?
Yes No a. If yes has the grantee earned more than
$100 during the most recent fiscal year?
b. If yes, has the amount over @100 been returned to DCA?
Perform a spot check on back up documentation for disbursements. List disbursements examined, amount, payee, check number and authorization. If the check reveals any instances of unnecessary, unreasonable, or unallowable costs, make a copy of the documentation and attach to the monitoring sheet.
Requisition Number:
Total Amount:
Date of EFT:
Check # Date
Total:
Amount Vendor Authorization (Y/N)
Requisition Number:
Total Amount:
Date of EFT:
Check # Date
Total:
Amount Vendor Authorization (Y/N)
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Revised October 1, 2014 http://www.nccommerce.com/rd/community-assistance/investment-assistance/forms-resources

8.
Community Assistance (CA)
Community Development Block Grant
Are any local staff persons (full or part time) paid from CDBG funds? If no proceed to next section.
Name FTE Job Title Duties Salary Paid to Date
9.
Are the amounts charged reasonable when compared to time worked, responsibilities of the workers, and the needs of the grant? Describe any discrepancies or concerns.
10.
11.
Are there time sheets on file that are signed by the employee and conform to payroll records?
Describe any discrepancies or concerns.
Debarment
Is there evidence that the grantee is using the federal and state debarment lists prior to procuring goods and services? Describe the method used by the grantee and identify their documentation of the process.
12.
Does the grantee intend to purchase equipment or real property with CDBG funds? If yes, what is the anticipated purchase date?
Yes No
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Revised October 1, 2014 http://www.nccommerce.com/rd/community-assistance/investment-assistance/forms-resources

13.
Has the grantee purchased equipment or real property with CDBG funds?
14.
Describe the equipment (make, model etc.) or provide a description of real property purchased.
15.
What procurement method was used?
16.
What is the purchase price of the equipment or real property?
Community Assistance (CA)
Community Development Block Grant
Yes No
17.
List the check number, date, and amount of the check issued for the purchase?
18.
Does the purchase price meet the grantee’s threshold for depreciation?
19.
Is the equipment or real property listed on the grantee’s inventory record?
20.
Is the purchase allowable under current guidelines?
21.
If not, what is the suggested remedy?
22.
23.
Is the grantee reminded to reflect the purchase on the Property Disposition Report form at closeout?
Grantee Allowable Costs, Indirect Costs, Cost Allocation
Are allowable cost guidelines, pursuant to
Circular OMB A-87 being followed? What documents support compliance or non- compliance?
Yes NO (Explain)
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24.
Are any indirect costs being charged to the grant?
(i.e. electricity, rent, phones, postage, copies etc.)
Community Assistance (CA)
Community Development Block Grant
25.
If yes, has the plan been approved by CA?
26.
What is the basis for the allocation of costs? (i.e., square footage, hours, FTEs etc.)
27.
Review the Indirect Cost Allocation Plan with actual expenses charged to the grant. Are the amounts charged reasonable when compared with time worked, responsibilities, and the needs of the grant? If not state any problems or concerns.
28.
Grantee Program Income
Are revenue generating activities being undertaken? If yes, complete the table below:
Date of Receipt Source Amount
Total:
29.
Has the grantee established a revenue account to record the receipt of program income?
Describe the adequacy of the process.
30.
Did the grantee expend program income before requesting additional drawdowns of CDBG funds?
If no, explain:
Use CA Approval?
Yes No
Yes No
Yes
Yes
Yes
Yes
No
No
No
No
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Revised October 1, 2014 http://www.nccommerce.com/rd/community-assistance/investment-assistance/forms-resources

31.
Were all expenditures of program income for
CDBG eligible activities?
Community Assistance (CA)
Community Development Block Grant
32.
Non-CDBG Funds
Are there any local or non-local funds committed to the grant? If yes, complete the chart below:
33.
Source of Funds Amount Committed
Total:
If non-CDBG funds are not fully expended, indicate the anticipated date of final expenditure. Note any problems or non- compliance.
NOTES:
Expended to Date
*List or attach supporting documentation or notate items reviewed to support work performed where deemed necessary for all questions listed on this monitoring checklist.
_________________________________________ ____________________
Date Grantee Representative
____________________________________
Grant Management Representative
___________________
Date
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