HomeMy WebLinkAboutAgenda - 05-21-1997 - 8g 1
s ORANGE COUNTY
Board of Commissioners
Action Agenda
Item No.�
Action Agenda Item Abstract
Meeting Date: May 21,1997
Subject: 1997-98 Contract between the NC Department of Environment,Health and Natural Resources and the
Orange County Health Department.
Department:HEALTH Public Hearing Yes X No
Budget Amendment Needed Yes X No
Attachments(s): Information Contact:
(1) Twelve Page Contract Health Director's Office X2411
(2) FEDERAL ASSURANCE AGREEMENTS Telephone Number
(3) Local Health Department Budget Pages Hillsborough-732-8181
Chapel Hill-968-4501
Mebane-227-2031
Durham-688-7331
Purpose:
To approve the annual consolidated contract between the NC Department of Environment,Health and Natural
Resources(DEHNR)and the Orange County Health Department,which provides State and Federal funds to the
Health Department to partially support mandated services.
Background:
The attached contract stipulates the state contract support in the amount of four hundred fifty-six thousand five
hundred fifty-one($456,551)for the programs listed below. This is a reduction of thirty-three thousand three
hundred twenty-eight($33,328),or 7°/a The reason for the reduction is a decline in federal block grant funding
for Maternal Health, Child Health,and Family Planning services.
General CSHS Orthopedic
Communicable Disease Maternal Health
Tuberculosis Child Health
AIDS(Federal) Adult Health
Family Planning Breast&Cervical Cancer
Child Service Coordination Health Promotion
Immunization Action Plan Environmental Health
Food and Lodging
Each year the State contracts with the Health Department to render specified,mandated services. The attached
contract outlines the terms in dollar amounts for each program activity as well as local allocations and revenues
which support these mandated services. Minor changes in the contract terms are acceptable and do not
substantially alter the working relationship.
Recommendation:
The Manager recommends that the Board approve the contract,subject to the endorsement of the County Attorney
and County Purchasing Director and authorize the Chair to sign the contracts,assurances and budget pages.
Page 1 of 12 2
CONSOLIDATED CONTRACT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE STATE HEALTH DIRECTOR
(Hereinafter called the"State")
AND
ORANGE COUNTY HEALTH DEPARTMENT
(Local Health Department—Hereinafter called the"Department")
FOR THE PURPOSE OF
MAINTAINING AND STIMULATING THE ADVANCEMENT OF
HEALTH IN NORTH CAROLINA
This Contract Shall Cover a Period From
July 01, 1997 to June 30, 1998
NOW,THEREFORE, the State and the Department agree that the provisions and clauses herein set forth
shall be incorporated in and constitute the terms and conditions applicable for the following activities
involving State funding. (State funding or funds means state, federal, and/or special funding or funds
throughout this contract)
ACTIVITY ACTIVITY
General 4110' Comp Breast & Cervical Cancer Control 5452
Communicable Disease 4510 Adult Health 5502
AID—TO—COUNTY 5331 Health Promotion 5503
Environmental Health 4751 Immunization Action Plan 5715
Food and Lodging 4752
Childhood Lead Poisoning Prevention 4754
Maternal Health 5101
Family Planning 5151
Child Service Coordination 5318
CSHS Orthopedic 5323
Child Health 5351
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Page 2 of 12
A. WORK TO BE PERFORMED
1. The Department shall perform activities in compliance with applicable program rules
contained in the North Carolina Administrative Code as well as all applicable Federal and
State laws and regulations.
2. The Department shall submit for approval the required Program Contract Addenda for
State funded budgets.
3. Tile Department shall submit completed reports as required by budgeted funding criteria
and as specified in Listing of Required Fiscal and Statistical Reports (Addenda 1).
4. The Department shall administer and enforce all rules which have been adopted by the
Commission for Health Services or approved by the State and adopted by the Local Board
of Health.
5. The Department shall provide to the State copies of rules adopted by the Local Board of
Health pursuant to G.S. 130A-39 and Public Health Ordinances adopted by the County
Commissioners. Copies of existing rules and ordinances shall be submitted to the State
Health Director within 45 days. Thereafter, copies of rules adopted shall be submitted
within 30 days of adoption.
6. The Department shall provide to the State a Community Diagnosis Prioritization of
Problems every biennium. The Department shall also provide a Community Diagnosis
narrative, if completed.
B. FUNDING STIPULATIONS
1. Funding for this contract is subject to the availability of State, Federal, and special funds for
the purpose set forth in this Contract.
2. During the period of this Contract, the Department shall not use State, Federal or Special
Project funds received under this Contract to reduce locally appropriated funds as reflected
in the Local Health Department Budgets.
3. The Department shall not use personal health program funds to support environmental
health personnel nor use environmental health program funds to support personal health
programs.
4. Fees generated by the Food and Lodging fees collection program may only be used to
support Environmental Health activities.
5. Funds for Childhood Lead Poisoning Prevention may be used to support both
environmental health and child health activities. -
6. The Department shall comply with Standards for Mandated Public Health Services, 15A
NCAC 25, Section .0200; and Administrative Procedures Manual for Federal Block Gant
Funds• 1 NCAC 33, Sections .0100 - .1502.
7. The Department shall maintain employee time records for the contract period documenting
the portion of time that each employee attributes to each activity when State funds are
budgeted for the support of employee salaries and fringe benefits. The percentage of time
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Page 3 of 12
each employee spends in each activity shall be converted to dollars based upon the
employees' salary and benefits. These records will serve to document salary and benefit
expenditures reported on Local Expenditure Report Form DEHNR 2949 and Local
Expenditure Report -WiC Form DEHNR 2950, and compliance with Chapter 479, Section
99 of the 1985 Session Laws.
8. Tine Department participating in Medicaid Reimbursement shall:
a. Comply with the terms of the Interagency Agreement between the Division of
Medical Assistance, Department of Human Resources and the Department of
Environment, Health, and Natural Resources and the Provider Participation
Agreement effective October 1, 1992 and any subsequent approved addenda or
new Agreement approved and established during the period of this contract.
b. Make every reasonable effort to collect its cost in providing services, for which
Medicaid reimbursement is sought, through public or private third party payors
except where prohibited by Federal regulations or State law. No one shall be
refused services solely because of an inability to pay.
9. The Department agrees to match the expenditure of Adolescent Pregnancy Prevention
Project grant funds with any in-kind source or newly generated funds, public or private
available to the project. Payment from the State shall be in accordance with G.S. 130A -
131.15 (d) (5) through (8). _
10. Funds budgeted for Adolescent Pregnancy Prevention Activities shall not be expended for
dues or out-of-state travel unless prior approval is received from the program.
11. Subject to the approval of the appropriate Division, a local health department may seek
reimbursement for services covered by a program operating under 15A NCAC 24A-rules
when those services are not supported by other state or federal funds. AIL payment
program rules and procedures as specified in the Purchase of Medical Care Services
manual must be followed.
12. Subject to the availability of funds and approval of the Office of Public Health Nursing, a
local health department may request reimbursement for
a. Nursing service personnel participating in the Introduction to Principles and
Practices of Public Health and Public Health Nursing course (2 week course) and
the Public Health Nurse Supervisors Training Course (3 week course).
Reimbursement is limited to no more than $200.00 per week per participant upon
successful completion of the course.
b. Community Health Assistants and Public Health Nurses attending certain pre-
approved Continuing Education courses offered by the Office of Public Health -
Nursing. Reimbursement is limited to $25.00 per participant per event.
13. The Department shall have an annual audit performed in accordance with The Single Audit
Act of 1984 as implemented by OMB Circular A-128. The audit report should be submitted
to the Office of the Controller within (six) 6 months following the close of the contract. Audit
findings and resolution of said findings shall be handled by the Office of the Controller.
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Page 4 of 12
14. Equipment is a type of fixed asset consisting of specific items of property that: (1) are tangible in
nature; (2) have a life longer than one year, and (3) have a significant value.
a. For Budgeting and Reporting Purposes
1. Equipment purchases meeting the above definition and having an
acquisition cost of$500 or more must be budgeted and reported in Line Item
5000.
b. For Inventory Purposes
1. Equipment must be accounted for in accordance with Local Government
Accounting System Procedure No. 15.
2. Wcmen, Infants and Children Program
All equipment with an acquisition cost of$500.00 or more must be
inventoried with the Division of Maternal and Child Health.
C. For Prior Approval Purposes
1. Equipment purchased or equipment leased where there is an option to
purchase with State/Federal funds must receive prior written approval from
the appropriate Division, Section, or Branch when the acquisition cost
exceeds $500.00.
2. Women, Infants and Children Program
All medical equipment and computer equipment, regardless of cost and all
other equipment with an acquisition cost of$500.00 or more must receive
prior approval from the program office. -
3. Equipment purchased with program income generated by the expenditure of
Title X Family Planning Funds with an acquisition cost of$500.00 or more
must receive prior written approval from the program.
4. The use of Maternal and Child Health program generated Medicaid fees for
capital improvements requires prior written approval from the program.
C. FISCAL CONTROL
1. The Department shall comply with the Local Government Budget and Fiscal Control Act,
North Carolina General Statute Chapter 159, Article 3.
a. The Department shall maintain a purchasing and procurement system in
accordance with generally accepted accounting practices and procedures set forth
by the Local Government Commission.
b. The Department shall execute written agreements with all parties who invoice the
Department for payment for the provision of services to patients.
C. When subcontracting, the following conditions must be met:
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Page 5 of 12
1. The Department is not relieved of any of the duties and responsibilities
provided in this contract.
2. The subcontractor will agree to abide by the standards contained herein or
to provide such information as to allow the Department to comply with these
standards.
3. The subcontractor will agree to allow state and federal authorized
representatives access to any records pertinent to its role as a subcontractor
of the Department.
4. The Department will make available to the State upon request a copy of
subcontracts supported with State/Federal funds.
d. The Department shall receive prior approval from the State when subcontracting for
services in the Women, Infants and Children Program.
e. The Department shall retain all budgets, budget revisions, contracts, contract
addenda, and financial records in accordance with the current Records Disposition
Schedule for County and District Health Departments issued by the Division of
Archives and History, Department of Cultural Resources.
2. The Department shall prepare and maintain a budget for each activity covered by this
contract in a manner consistent with instructions provided with Local Health Department
Budget-WIC Form DEHNR 3370 (Revised 2/93) and Local Health Department Budget
Form DEHNR 2948 (Revised 2/93).
a. The Department shall prepare budget revisions for prior approval of the State when
those revisions are in the School Health Program (Line Item 6200).
b. The Department shall-prepare budget revisions for prior approval of the State when
State funds will be increased or decreased.
C. The Department shall prepare an informational copy for the State of all other budget
revisions when proposed expenditures exceed the line amount budgeted.
d. The Department shall submit all revisions prior to the end of the term specified in
this Contract. Budget revisions received by the State after the end of the contract
period will be returned without action.
3. The Department shall observe the following conditions when budgeting and reporting
earned revenues:
a. All payments from persons, and public or private third party payors, shall be utilized
for the activity that generated the revenue and shall not reduce or replace locally
appropriated funds during the period of this contract. The Department may use
revenues from any Division of Maternal and Child Health supported activity in any
other activity supported by the Division.
b. All earned income must be budgeted in the program where earned, except that
income earned by a program which has no activity budget can be budgeted in a
program approved by the State. With regard to revenue generated by matemal and
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Page 6 of 12
child health related services, program is defined as any activity supported by the
Division of Maternal and Child Health.
C. Ali fees collected shall be used in the current year or succeeding fiscal years.
d. Use of program income generated by the expenditure of Federal categorical funds
will be governed by applicable Federal regulations, including but not limited to 45
CFR 74.
e. When budgeting:
I. Line item 9000 on the program budget must be used to budget the total of
line items 101, 102 and 103.
ii. Line item 102 on the program budget must be used to budget TXIX earned
revenues.
iii. Line item 103 on the program budget must be used to budget other earned
revenues.
f. When reporting:
!. Line item 9000 on the Local Expenditure Report must be used to report the
total of fine items 101, 102, 103.
ii. Line item 102 on the Local Expenditure Report must be used to report TXIX
earned revenues that were expended.
iii. Line item 103 on the Local Expenditure Report must be used to report other
earned revenues that were expended.
g. A local account shall be maintained for unbudgeted/unreported TXIX fees.
Accounts shall be maintained in sufficient detail to identify the program source
generating the fees.
h. Title XIX revenues carried forward at the end of fiscal year 1998 may not
exceed Title XIX revenues earned during fiscal year 95-96 or$10,000.00
whichever is greater.
1. Program budgets that do not include an amount of TXIX funds sufficient
to meet the requirements of 3. h. will not be approved by the State.
4. The Department shall submit a quarterly report of actual receipts and
expenditures of the Department according to instructions provided with Local
Expenditure Reports, Form DEHNR 2949 (Revised 8/95) and Form DEHNR
2950 (Revised 2/93).
a. The Department shall submit quarterly expenditure reports to the State
within 45 days from the end of the reporting quarter. Failure to meet the
reporting deadline will result in an immediate suspension of payments
until the overdue report is received.
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Page 7 of 12
0
b. The Department shall submit the final Expenditure Report to the State
within 45 days after the and of the contract period. Report is due by
August 14.
C. The Department shall submit amended or corrected expenditure reports
within four(4) months after the end of the contract period. Any such
reports must be prepared for the specific quarter to be amended or
corrected. Reports received after October 31 will be returned without
action.
d. The Department shall refund to the State all State funds not supported by
expenditures within 45 days after notification of overpayment. When
payment is not received by the State within 45 days, future payments to
the Department may be reduced by the amount due or payments may be
suspended until the refund is received by the State.
e. The Department shall follow Women, Infants and Children Program and
other Federal program reporting requirements when they differ from
those stated above.
f. The Department shall submit monthly WIC expenditure reports to the
State no later than the 8th of the following month. Final expenditure
report is due by August 14.
g. Reimbursement of WIC approved expenditures for July, August, and
September cannot exceed one-fourth of the total budget for the contract
period.
h. The_Department shall submit monthly Minority Infant Mortality Reduction
expenditure reports to the state no later than the 15th of the following
month.
1. The Department shall submit expenditure reports for Mosquito Control
activity in accordance with 15A NCAC 18B, Sections .0104 and .0107.
j. The Department shall submit request for payment for services provided
under 15A NCAC 24 A rules to the Claims Processing Unit, Purchase of
Medical Care Services, DEHNR-
k. The Department shall submit request for reimbursement for nurse training
to the.Office of Public Health Nursing. Form DEHNR 3300- Public
Health Nurse Training Activity must be used as the invoice for payment.
5. The Department shall submit on an annual basis Staff Time Activity Report,
DEHNR 3389, Environmental Health Report, DEHNR 3738, and Food and
Lodging Report, DEHNR 3888. The reports shall accompany the final
expenditure report and must be received by the State within 45 days after the
end of the contract period.
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Page 8 of 12
D. PERSONNEL POLICIES
The Department shall adhere to and fully comply with State personnel policies as found
in North Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include,
but are not limited to, the following:
1. Equal employment opportunity;
2. Affirmative action;
3. Policies for local government employment subject to the State Personnel Act;
4. "Local Classification and Salary Range";
5. "Compensation Policy for Local Competitive Services Employees"; and
6. "Recruitment and Selection Policy and Procedures";
7. Environmental Health Specialists employed by the Department shall be
delegated authority by the State to administer and enforce State environmental
health rules and laws as directed by the State pursuant to G.S. 130A-4(b). This
delegation shall be done according to 15A NCAC 18A .2300.
a. Local health departments are responsible for sending their newly-
employed environmental health specialists (intems) to 33 days (6.5
weeks) of initial field traininglorientation at the training center within 180
days from date of employment.
b. Arrangements for initial field traininglorientation for newly-employed
environmental health specialists will be handled by the Education and
Training Staff, Division of Environmental Health.
C. A local health department which is contracting with an environmental
health specialist employed by another department shall be responsible
for assuring that all original documents, correspondence, and other public
records be maintained in the health department using the contractor and
the contract shall stipulate that the contractor shall be available for
consultation to the public being served.
8. The Department shall comply.with Minimum Standard Health Department.
Staffing 15A NCAC Section .0301(c), and shall assure that all nursing staff who
provide public health services funded by this contract comply with this rule.
E. CONFIDENTIALITY
All information as to personal facts and circumstances obtained by Department
personnel in connection with the provision of services or other activity under this
Contract shall be privileged communication, shall be held confidential, and shall not be
divulged without the responsible person's written consent except as may be otherwise
required by applicable law or regulation. Such information may be disclosed in
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Page 9of12
summary, statistical, or other form which does not directly or indirectly identify particular ,
individuals.
F. CIVIL RIGHTS
1. The Department shall assure that no person, on the grounds of race, color, age,
religion, sex, marital status, immigration status, or national origin (unless
otherwise medically indicated) or otherwise qualified handicapped individual
solely by reason of his/her handicap be excluded from participation in, be denied
the benefits of, or be subjected to discrimination under any program or activity
covered by this Contract.
2. The Department shall complete HHS Form 441, Assurance of Compliance with
the Department of Health and Welfare regulations, under Title VI of the Civil
Rights Act of 1964; for the Women, Infants and Children Program, FNS-64,
Assurance of Compliance with the Department of Agriculture Food and Nutrition
Service, under Title VI of the civil Rights Act of 1964; and HHS Form 641,
Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973.
3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate
in employment against a qualified individual with a disability and outlaws
discrimination against individuals with disabilities in State and local government
services and public accommodations. The Department certifies that it and its
principals and subcontractors will comply with regulations in A.D.A. Tibe I
(Employment), Title II (Public Services), and True III (Public Accommodations) in
fulfilling the obligations under this agreement.
G. RESPONSIBILITIES OF THE STATE
1. The State shall provide to the Department upon request technical assistance in
the preparation of the Consolidated Contract, Activity Budgets and Contract
Addenda.
2. The State shall specify those administrative forms/reports and their respective
revision dates that are required by particular activities pertaining to the
Department's budget with the State in Listing of Required Fiscal and Statistical
Reports (Addendum 1)for the contract period. New forms/reports not listed in
Required Fiscal and Statistical Reports shall be implemented during a contract
period only with the approval of the State Health Director.
3. The State shall provide to the Department within thirty (30) days after receiving
an acceptable activity budget from the Department an approved signed copy of
the budget. -
4. The State shall provide funds to the Department upon approval of the Contract
Addenda, activity budgets, and signing of this contract.
5. The State shall assist the Department to comply with all applicable laws,
regulations, and standards relating to the activities covered in this contract.
6. The State reserves the right to conduct reviews to determine compliance with the
terms of this contract.
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Page 10 of 12
7. The State shall be assured that the Department maintains expenditure of locally
appropriated funds for maternal health, child health, and family planning activities
equal to or greater than that reported on the Staff Time Activity Report for the
period beginning July 1, 1984, and ending June 30, 1985. 71is maintenance of
effort shall be measured by salary equivalencies which are to be maintained in
accordance with Section B. 7. of this contract.
H. DISBURSEMENT OF FUNDS
The State shall disburse funds to the Department as follows:
1. Provided the Consolidated Contract is properly executed and all quarterly
expenditure reports are filed within the established time frames, payments equal
to 1112 of the total program approved budget shall be made in the following
months:
July August September October November January February
April May
Based on expenditures reported for the first, second, and third quarters,
payments shall be adjusted'either upward or downward, in payments made in
the following months:
December March June
2. For departments selecting quarterly reimbursement option, payments shall be
made when the quarterly expenditure report is received.
3. For departments receiving Rural Obstetrical Care Incentive funds, payment of
such funds shall be made in one lump sum the month following receipt and
approval of the activity budget.
4. For departments receiving Minority Infant Mortality Reduction project funds,
payment will be based on actual reported expenditures. Monthly payments will
be made provided that expenditure reports are received as required in C. 4. h.
5. Food and lodging fees will be disbursed to the department in one sum the month
following receipt and approval of the activity budget and any subsequent budget
revisions.
S: Funds for Childhood Lead Poisoning Prevention will be disbursed once per year.
The amount will be determined by the number of confirmed cases identified in
each county. A separate contract addendum must be submitted with budget
page in order to receive these funds. Funds for training will be disbursed upon
request.
7. Quarterly payment for reported expenditures in Line Item 1000 shall be limited to
one-fourth of the budgeted amount in that line item.
8. Increased or decreased payments necessitated by changes in the total budgeted
amount will be reflected in the monthly payments subsequent to approval of the
budget revision.
Page 11 of 12 12
9. Payments shall be suspended when expenditure reports are not received by the ,
time specified in C. 4. a and f. Payments will resume in the months subsequent
to receipt of the expenditure reports.
10. Payment is limited to the total amount of the budget by line item as reported on
Expenditure Report DEHNR 3389,
11. Final payments will be made based on the 4th quarter expenditure report. Final
payments will be equal to the difference between approved reported
expenditures and the sum of previous payments. Final payments should be
made not later than September provided that an original signed copy of an
expenditure report for each quarter has been received by the Office of the
Controller. Final payment will be made only after the Staff Time Activity Report,
DEHNR 3389, Environmental Health Report, DEHNR 3788, and Food and
Lodging, DEHNR 3888 are received by the State.
I. AMENDMENT OF CONTRACT
Amendments, modifications,,or waivers of this contract may be made at any time by
mutual agreement of all parties. Amendments shall be in writing and signed by
appropriate authorities.
J. PROVISION OF TERMINATION
This contract may be terminated for reasons other than non-compliance upon sixty (60)
days written notice by either party. If termination should occur, the Department shall
receive payment only for allowable expenditures.
The State may withhold payment to the Department until the State can determine
whether the Department is entitled to further payment or whether the State is entitled to
a refund.
K. COMPLIANCE
1. The State shall assure compliance with all terms of this contract.
a. Upon determination of non-compliance, the State shall give the
Department sixty (60) days written notice to come into compliance. If the
deficiency is corrected, the Department shall submit a written report to
the State which sets forth the corrective action taken.
b. If the above deficiencies should not be corrected to the satisfaction of the
State after the sixty (60) day period, disbursement of funds for the
particular activity may be temporarily suspended pending negotiation of a
plan of corrective action.
C. If the deficiency is still not corrected within the next thirty (30) days
following temporary suspension of funding, program funds may be
permanently suspended until the Department can provide evidence that
the deficiencies have been corrected.
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d. In the event of the Department's non-compliance with clauses of this
contract, the State may cancel, terminate, or suspend this contract in
whole or in part and the Department may be declared ineligible for further
State contracts or agreements. Such terminations for non-compliance
shall not occur until: (1) the provisions of Secbcn K-1 (a-c) have been
followed, documented, and have failed to provide a resolution, (2) all
other reasonable administrative remedies have been exhausted.
2. If the Department or the State should be determined out of compliance with the
provisions of the contract, either party may file a formal appeal with the Office of
Administrative Hearings.
IN WITNESS WHEREOF, the Department and the State have executed this
agreement in duplicate originals, one of which is retained by each of the parties.
LOCAL SIGNATURES STATE OF NORTH CAROLINA
Health Director Date
By
State Health Director
or Authorized Agent
Finance Officer Date
Chairman of County Commissioners Date
(when required)
D:—'uA2T: -YT OF HEALTH APID HL`M.LN SERY]CES 14
ASSURANCE OF COMPLIANCE WITH SECTION $04 OF THE
REHABILITATION ACT OF 1973, AS AMENDED
The undersigned (hereinafter called the"re pient") HER:BY AGREES.THAT it will comply
with Section 344 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 7K, all require-
ments imposed by the applicable HHS regulation(45 C.F.R. Part 84), and III guidelines and
interpretations issued pursuant thereto.
Pursuant to 134.3(a)of the regulation [43 C.F.R. 84.3(a)], the r:cpient gives this Assurance
in consideration of and for the purpose of obtaining any and 211 Federal 3rants, loans, can-
tracts (except procurement contracts and contracts of insuranc:or guaranty), property, dis-
counts, or other Federal financial assistance extended by the Department of Health and human
Services after the date of this Assurance, including payments or other assistance made after
such date on applications for Federal financial assistance that were approved before such
date.T he recipient recognizes and agrees that such Federal financial assistance will be extended
in reliance on the representations and agreements made itrthis Assurance and that. the United
States will have the right to enforce this Assurance through lawful means. This Assurance
is binding on the recipient, its successors, transferees, and assignees, and the person or persons
whose signatures appear below are authorized to sign this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which Federal financial assistance
is extended to it by the Department of Health and Human Services or, where the assistance
is in the form of real or personal property, for the period provided for in §84.5(b) of the
regulation [45 C.F.R. 84,5(b)].
The recipient: (Check (a) or (b))
a. ( ) employs fewer than fifteen persons;
b. ( ) employs fifteen or more persons and, pursuant to §84.7(a) of the regulation
145 C.F.R. 84.7(a)J, has designated the following person(s) to coordinate its
efforts to comply with the HHS regulations:
Daniel B. Reimer
Name of Designees) (Type or Print)
Orange County Health Department PO Box 8:81
Name of Recipient4Type or Print) Street Address or P.O. Box
56-6000327 Hillsborough
(IRS) Employer Identification Number City
North Carolina 27278-8181
State Zip
I certify that the above information is complete and correct to the bat of my knowledge.
Date Signature and Title of Authorized Official
If there has been a change in name or ownership within the last year, please PRINT the former
name below:
MRS-"I titer. �zs.�
15
ASSURANCE OF COMPLIANCE IV= THE DEPARTS:NT OF
HEALTH A.ND HUNL0 SERVICES REGULATION UNDER
TITS VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department
(yereinafter called the "Applicant")
Name of Applic= (tM or 7xia)
IZRE3Y AGREES TEAT it will comply with Title VI of the Civil Rights A.of 1964 t°.L.
33-352) and all requireme-nts imposed by or pursuant to the Regulation of the Department
of Health and Human Services (45 C.F.R. Part 30) issued pursuant to that title, to the end
that, in ac_ordancs with Title VI of that Act and the Regulation, no person in tar United
States shall, on the ground of race, color, or national origin, be excluded from participation
in, be denied the benefits of, or be otherwise subjected to discrimination under any program
or activity for which the Applicant receives Federal finaneW assistance from & Depart-
ment; and HER-=3Y GIVES ASSURANCE THAT it will immediately take any measures
necessary to eflectuate this agreement.
If any real property or structure thereon is provided or improved with the aid of Federal
financial assistance extended to the Applicant by the Department. this Assurance shall obligate
the Applicant. or in the case of any transfer of such property, any transferee, for the period
during which the real property or structure is used for a purpose for which the Federal financial
assistance is extended or for another purpose involving the provision of similar services or
benefits. If any personal property is so provided, this Assurance shall obligate the Applicant
for the period during which it retains ownership or possession of the property. In all other
cases, this Assurance shall obligate the Applicant for the period during which the Federal
financial assistant: is extended to it by the Department.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and
all Federal grants, loans, cantracts, property, discounts or other Federal financial assistance
extended after the date hereof to the Applicant by the Department, including installment
payments after such date on account of applications for Federal financial assistance which
were approved before such date.The Applicant recognizes and agrees that such Federal finan-
cial assistance will be extended in reliance on the representations and agreements made in
this Assurance, and that the United States shall have the right to seek judicial enforcement
of this Assurance. This Assurance is binding on the Applicant, its successors, transferees,
and assignees, and the person or persons whose signatures appear below are authorized to
sign this Assurance on behzlf of the Applicant. `
Date Orange County Health Depart.ment
Applies= I&"* at pna)
By
SiVmtwe mW Tole of Awsa.ues Ottiaa)
MRS-W (1". 12/22)
16
►e■.
U6r Food and Nutrition Servits
ASSURANC; OF CCMPLIANC? WITH THE DEPARTMiNT CF AGRICULTURE,
FCCD AND NUTRITION 52XVICc, UNDER TITU VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department
tame of Applicant)
(Y.arsinsiter called the "applicant.")
3v—MT AC'LZS THAT it gill eoe:;ly vi:h Title VI any inprovene-.:s made vith Federal financial
of the Civil 21ght2 Act of 1964 ML. 33-352) assistants extended to the Applicant by the
and all requismsnts imposed by the 1tetulstion3 Department. This includes any Federal agreement,
of the Department of Agriculture (7 CS ?art 13), arrangement. or other contract vhich has as one
Depsr Gent of Justice (23 CTR Tarts 42 i 30), of its purposes the provision of assistance such
and FINS directives or regulations issued as food, food stamps, cash assistants for the
pursuant to that Act and the legulatlons, to the purchase of food, and cash assistance for purchase
effect that, no person in the vai:&d Stases shall, or rental of food service equipsent or any other
on the ground of race, color, or national origin. financial assistance extended in reliance on the
be excluded from participation in, be denied the representations and agreements made in this
benefits of, or be ochervise subject to discrimi- assurance.
nation under any prograo or activity for vhich the
Applicant received Federal financial assistance 3T ACCZnINC THIS ASSUAA.%iC_, the applicant &trees
froe the Depar=eat; and IMM! CIVTS A.SSURAsCI to coepile data, maintain records and subait
THAT it will ire ediately take any measures reports as required, to permit effective enforce-
necessary to effsc::sste this agreement. aent of Title V; and pe='t authorized USIA
personnel during normal working hours to review
THIS ASSURANCE is given In consideration of and such records, books and accounts as needed to
for the purpose of obtaining any and all Federal Ascertain cogliance with Title VI. If there are
financial assistance. grants and loans of Federal any violations of this assurance, the Department
funds, reimbursable expenditures. grant or of Agriculture, Food and Nutrition Service, shall
donation of Federal property and interest in have the right to seek Judicial enforcement of
property, the detail of Federal personnel, the this assurance.
sale and lease of, and the permission to use,
Federal property or interest in such property or This assurance is binding on the applicant, its
the furnishing of services vitbout consideration successors, transferees, and assignees as long as
or a: a nominal consideration, ar st a consider- it receives assistance or retains possession of
ation which 1s reduced for the purpose of assist- any assistance from the Department. The person
ing the recipient, or in recognition of the or persons whose signatures appear below are
public interest to be served by such sale. lease. authorized to sign this assurance on the behalf of
or furnishing of services to the recipient. c the applicant.
Dated Orange County Health Department
(Applicant)
ly
(.!:le of authorized official)
PO Box 8181
Hillsborough NC 27278
Wddrsss of applicant)
No further monies or other benefits may be paid out under Food and Nutrition. Service Federal assistance
programs unless thts Assurance is costrlered and filed as required by existing regulations (7 CFR 13).
LOCAL HEALTH DEPART TENT BUDGET 17
N.C. Department of Environment,
• Health,and Natural Resources Revision Number
Division of General Services
SFY Division of General Services .
P. O. Number
7 / 97 6 / 98 9 8 4 1 1 0 0 0 6 8
Effective Date Termination Date Contract Number
Contractor:
Orange County Health Department Activity: General
Project Director: Daniel B. Reimer Total Budget: $ 2-10,123
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1C00 54,361
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
N ::.
School Health
D
Clinician
I
Laboratory
Pharmacy Services
UTransfer TXIX :<:>:«<:::>::<::;::>::;:>.::;::>::.;::.;:<:;»::<...- :.:,... :....1.
R Subtotal State Expend. $ 54,363
E LOCAL EXPENDITURES: LOCAL EXP 9000 175 760
S TOTAL EXPENDITURES—equal to Total Receipts $ 230,123
LOCAL FUNDS: 0
R Appropriation APPROP 101
TXIX TXDC 102 95,360
E Other Receipts OTHR REC 103 80 400
C Subtotal_Local Funds $ 175 760
E STATE/FEDERAL/SPECIAL FUNDS:
I
P
T
S $ 54,363
Subtotal State/Federal/Special
TOTAL RECEIPTS—equal to Total Expenditures $ 230,123
Local Authorized Official Signature Date en�—d Division/Section Signature Date
Finance Officer Signature Date Acca�t Fiscal Management Signature Date
DEHNR 2948(Revised 2/93) -
Genml Services Division(Review 2/94)
N.C. Deparraenc of Environment, Revision Number
Health, and Natural Resources
Division of General Services Division of E idemiol
SFY P. O. Number
7 / 97 6 / 98 9 8 4 5 1 0 0 0 6 8
Effective Dare Termination Date
Contract Number
Contractor:
Orange county Health Department Acrivity: Communicable Disease
Project Director:
Daniel B. Reimer Total Budget:$ 32,806
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES: SA/FR 1000 17,018
Salaries & Fringe Benefits 2C00
X Operating Expenses OP EXP 5000
P Purchase of Equipment E UIP
E General Contracted or 6100
Purchased
Services
GENERAL
School Health `` '
D C CLN 6863
Clinician
Laboratory LAB 6862
T Ph armscY Services R...x..: ERV 6.8.•6..5:
LT Transfer TXIX
S 17,018
R Subtotal State Expend.
E LOCAL EXP 9000 15,788
LOCAL EXPENDITURES:
S TOTAL EXPENDITURES—equal to Total Receipts $ 32,806
LOCAL FUNDS: 101 0
R Appropriation APPROP
E TXIX
- �{ 102 3,288
Other Receipts OTHR REC 103
C S 15,788
Subtotal Local Funds
E STATF/FEDERAL/SPECIAL FUNDS:
I
P
T
S S 17,018
Subtotal smte/Federal/S ecial
TOTAL RECEIPTS —equal to Total Expenditures - 32,806
Local Authorized Official Signature Date B�+ � Division/Section Signature Date
Finance Officer Signature Date Fiscal Management Signature Dace
DEHNR 2948(Revised 2/93)
General Services Division(Rcvicw Z/94)
L.UL.3L tIL�Llri Utt'AlCi_ti1L.v 1 0�, uuc,l l�
N.C. De-pa rcnent of Environment.
Health, and Natural Resources Revision Number _
Division of General Services ____
SrY 98 Division of Epidemiology* P. O. Number
7 / 97 6 98 9 8 4 -- 5 3 3 1 0 6 8
Eirective Date Termination Date Contract Number
Con=cor: Orange County Health Department Activity: AID-TO-COUNTY (FEDERAL)
Project Director: Daniel B. Reimer 'Total Budget: $ 31,000
ITEM. DESCRIPTION I CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
Salaries &. Fringe Benefits SA/FR 1000 29,750
X Operating F--cpenses OP EXP 2CC0 1
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GEIERAL 6100
Sclhool Health SCf HL'£ .: 6ZE I
D Clinician LI ' ...:;. €.......... . .,'6n63;.
I
Laboratory Imo$ Z
T Pharmacy Services
U Transfer TXL`{ fFi4
R Subtotal State E.r_end. $ 31,000
E LOCAL EXPENDITURES: I LOCAL EXP 9000 0
S TOTAL E=N--D ITURES —equal to Total Receipts $ 31,000
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 0
C Subtotal Local Funds $ 0
E
STATE/FEDERAL/SPECI.AL FUNDS:
I
P DEHNR 31,000
.I. 1601-1450-536961-4533-1177
S
Subtotal State./F� 31,000 eral/Soecial $
TOTAL RECEIPTS —equal to Total Expenditures $ 31,000
Local Authorized Official Signature Date erArla Hnd Division/Section Signature Date
Finance Officer Signature Dare Ac�vaw Fiscal Management Signature Date
)EHNR 2948(Revised 2/93)
3eneral Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET
N.C.Department of Environment,
Health, and Natural Resources Revision Number——
Division of General Services
SFY Division of Environmental Health ————P. O. Number
7 / 97 6 / 98 9 8 4 7 5 1 0 0 6 8
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity. Environmental Health
Project Director: Daniel B. Reimer Total Budget: $ 262,000
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 2,000
X Operating Expenses OP EXP 2000 2,000
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
N
.:
School Health >:�G s'� <?>><�>:.... ...
D
....................
.:::.. . ..:
; .
Clinician :: >' <<> '< < ............:::::...:...:.......
I
Laboratory LAB :6862
T
Pharmacy Services
U Transfer TXIX
R Subtotal State Expend. $ 6,000
E LOCAL EXPENDITURES: LOCAL EXP 9000 256,000
S TOTAL EXPENDITURES—equal to Total Receipts $ 262,000
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 256,000
C
E Subtotal Local Funds $ 256,000
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 6,000
T
S 6,000
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures - $ 262,000
Local Authorized Official Signature Date Branch Hod Division/Section Signature Date
WtW
Finance Officer Signature Date A« mnt Fiscal Management Signature Date
teitW
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET �y
N.C. Department of Environment,
• Health, and Natural Resources Revision Number--
Division of General Services
SFY Division of Environmental Health -----
P. O. Number
7 / 97 6 / 98 9 8 4 7 5 2 0 0 6 8
E fective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity:Food and Lodging
Project Director: Daniel H. Reimer Total Budget:$ 750.00
ITEM DESCRIPTION CLASSIFICATION ITEM AIMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 750.00
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL ....................6100
S ......drool Health
::.::::.. .......£fit _:....:.:...... _ -:,. ::.......::
D
Clinician
::.,....... .. 63.:.:..... ...........
I
Laboratory LAB
T �R
Pharmacy S ervices
SE
U Transfer TXIX .
R Subtotal State Emend. $ 750.00
E LOCAL EXPENDITURES: 7—LOCAL, EX? 9000 0
S TOTAL EXPENDITURES equal to Total Receipts $ 750.00
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXDC TXIX 102 0
Other Receipts OTHR REC 103 0
C
E Subtotal Local Funds $ 0
STATE/FEDERAL/SPECIAL FUNDS:
I
P DF.HNR $ 750.00
T
S
Subtotal State/Federal/Special $ 750.00
TOTAL RECEIPTS equal to Total Expenditures $ 750.00
Local Authorized Official Signature Date e=6 Head Division/Section Signature Date
Finance Officer Signature Date unom Fiscal Management Signature Date
DEWR Z948(Revised 2/93)
Gcncral Serrices Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 22
N.C. Deaart nenc of Environment,
Healch, and Natural Resources Revision Number --
Division of General Services
SFY Division of Environmental Health -----
P. O. Number-
7 97 6 /98 9 8 4 7 5 4 0 0 6 8
Effective Dace Termination Dace Contract dumber
Contractor:
ORANGE COUNTY HEALTH DEPAR' Activity:
ITNTE T Childhood Lead Poisoning Prevention
Daniel B. Reimer 1,500.00
Project Director: Total Budget: $
ITEM DESCRIPTION I CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 1,500
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
��:� ems.
School Health SCI3 ¢ s GZ430 �� `� �' � .F ..
Mev
Clinician
�
RE
Laboratory LAB 6862
T Pharmacy Services
U Transfer TXIX `� " r
y A.> ....:M. ',?d`rxf....Ye;:?{_,•A4.w A 4::... ,.x�'P�ru'a��,.5a,
R Subtotal State Exxnd. $ 1,500
E LOCAL EXPENDITURES: LOCAL EXP 9000 0
S I TOTAL EXPENDITURES —equal to Total Receipts $ 1,500
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 0 _
C
E Subtotal Local Funds $ 0
STATE/FEDERAL/SPECIAL FUNDS:
I
P
T
S
Subtotal State/Federal/Special $ 1,500 _
TOTAL RECEIPTS — equal to Total Expenditures $ 1,500
Local Authorized Official Signature Dace Bnoch H-d Division/Section Signature Dace
Finance Officer Signature Dace A«ou."I't Fiscal Management Signature Date
LOCAL HEALTH DEPARTMENT BUDGET
N.C.Department of Environment,
Health, and Natural Resources Revision Number
Division of General Services Division of Maternal and Child Health —————
SFY P. O.Number
7 / 97 6 / 98 9 8 5 1 0 1 0 0 6 8
Effective Date Termination Date Contract Number
Contractor:
Orange County Health Department Activi ty' Maternal Health
Project Director:
Daniel B. Reimer Total Budget: $ 248,472
ITEM DESCRIPTION CLASSIFICATION . ITEM AMOUNT
E STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 25,826
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
N school Health SOH Ili` 62
D CLN 6863
Clinic7an
I
Laboratory LAB 6862
T Pharmacy Services RX SERV 6865
U Transfer
R Subtotal State Expend. $ 25,826
E LOCAL EXPENDITURES: LOCAL EXP 9000 222,646
S TOTAL EXPENDITURES —equal to Total Receipts $ 248,472
LOCAL FUNDS:
R Appropriation APPROP 101 0
E
T= D( 102 222,646
Other Receipts OTHR REC 103 0
C $ 222,646
Subtotal Local Funds
E STATE/FEDERAL/SPECIAL FUNDS:
I
P DESrIR $ 25,826
T
S $ 25,826
Subtotal State/Federal/Soecial
TOTAL RECEIPTS—equal to Total Expenditures $ 248,472
Local Authorized Official Signature Date ,H°d Division/Sectioa Signature Date
Finance Officer Signature Date Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
24
LOCAL HEALTH DEPARTMENT BUDGET
N.C. Department of Environment, Revision Number——
Health, and Natural Resources
Division of General Services Division of Maternal and Child Health ———— —
SFY P. O.Number
7 / 97 6 / 98 9 8 5 1 -k U --fi- 8
Effective Date Termination Date Contract Number
Contractor:
Orange County Health Department - Activity: Family Planning -
Project Director:
Daniel B. Reimer Total Budget: $ 141,227
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES: SA/FR 1000 110.105
Salaries & Fringe Benefits E EXP 2000
X Operating Expenses 5000
P Purchase of Equipment —
E General Contracted or GENERAL 6100
Purchased Services
rI
School Health
D CLN 6863
Clinician :„•.
Laboratory 1” R 2 >
3
'r GG��``rr t ,�
F3 r� x
Pharmacy Services
U Transfer TXIX
R Subtotal State d. $ 110,105
E LOCAL EXPENDITURES: LOCAL EXP 9000 _
31,122
S TOTAL EXPENDITURES—equal to Total Receipts $ 141,227
LOCAL FUNDS: 0
R Appropriation APPROP 101
Tom{ 102 19,086
E TM C 103 12,036
Other Receipts OTHR RE
C $ 31,122
Subtotal Local Funds
E STATE/FEDERAL/SPECIAL FUNDS:
I FP $ 40,081
P
,I WHSF $
�c s 70,024 S $ 110,105
Subtotal State/Federal/St)edal
TOTAL RECEIPTS—equal to Total Expenditures $ 141,227
Local Authorized Official Signature Date armxh Hcad Division/Section Signature Date
Finance Officer Signature Date � Fiscal Management Signature Date
DO-NR 2948(Revised Z/93)
General Se-vices Division(Review 2/94)
L.J
LOCAL HEALTH DEPARTMENT BUDGET
N.C. Department of Environment,
Health,and Natural Resources Revision Number——
Division of General Services
SFY Division of Maternal and Child Health ————P.O.Number
7 / 97 6 / 98 9 8 5 3 1 .8 0 0 6 8
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity: Child Service Coordination
Project Director: Daniel B. Reimer Total Budget:$ 172,213
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 51.976
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health SCH HLTH 6200
D Clinician CLN 6863
............
T Laboratory LAB 6862
Pharmacy Services RX SERV 6865
..:Ci:.'R:>:';:' ;i..'yw >:.v>:o.:i t`.➢>y'`SrS
::.::.:*_��:>:>....:.. .:.::...:............ .k..�....,. .t:t¢:i AYr`o':Vii::>.,:.::._.......
U Transfer TXIX <:,.>.,,v«.:::::;,.>:::»..::..�:.�:.:,,>::>::::,>4:.>:.>:.>:<:<.>.>.��..:. .�
R Subtotal State Expend. $ 51,876
E LOCAL EXPENDITURES: LOCAL EXP 9000 120,337
S TOTAL EXPENDITURES—equal to Total Receipts $ 172,2 3 _
LOCAL FUNDS:
R Appropriation APPROP 101 0
E ZXD( TXIX 102 120.337
Other Receipts OTHR REC 103 0
C 120,337
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I
P
T
S
Subtotal State/Federal/S $ 51,876
TOTAL RECEIPTS—equal to Total Expenditures $ 172,213
Local Authorized Official Signature Date wh Had Division/Section Signature Date
Finance Officer Signature Date Amt Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
Lu
LOCAL HEALTH DEPARTMENT BUDGET
N.C.Department of Environment, '
Health,and Natural Resources Revision Number——
Division of General Services
SF, Division of Maternal and Child Health
P.O.Number
7 / 97 6 / 98 9 8 5 3 2 3 0 0 6 8
Effective Date Termination Date Contract Number
Contractor. Orange County Health Department Activity: CSHS Orthopedic
Project Director. Daniel B. Reimer Total Budget:$ 634.00
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health SCHILTH..4 b20Q .
D Clinician CLN 6863
I -.:
T Laboratory LAB 6862 634.00
Pharmacy Services RX SERV 6865
U Transfer T?QX
R Subtotal State Expend. $-T E LOCAL EXPENDITURES: LOCAL EX? 9000 0
S TOTAL EXPENDITURES—equal to Total Receipts $ 634.0
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TM 102 0
Other Receipts OTHR REC 103 0
C
E Subtotal Local Funds $ 0
STATE/FEDERAL/SPECIAL FUNDS:
I
P
T
S
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $ 634.00
Local Authorized Official Signature Date $rmeh Hed Division/Section Signature Date
Finance Officer Signature Date Acwun=x Fiscal Management Signature Date
Inmal
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
27
LOCAL HEALTH DEPARTMENT BUDGET
N.C.Department of Environment,
Health, and Natural Resources Revision Number——
Division of General Services
S�, Division of Maternal and Child Health ————P. O.Number
7 / 97 6 / 98 9 8 5 3 5 1 0 0 6 8
Effective Date Termination Date —^ Contract Number
Contractor: Orange County Health Department Activity: Child Health
Project Director: Daniel b. Reimer Total Budget: $ 204,826
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 70,555
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP _ 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health SCH HLTH 6200 10,573
D Clinician CLN 6863
T Laboratory LAB 6862
Pharmacy Services RX SERV 6865
U
Transfer TXIX
R Subtotal State Expend. $ 81.128
E LOCAL EXPENDITURES: LOCAL EXP 9000 123,698
S TOTAL EXPENDITURES—equal to Total Receipts $ ' 204,826
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TM TM 102
Other Receipts OTHR REC 103
C
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I Pediatric Primary Care
$ 81,12R
P Child Fatality Prev. Team
T School Health
Healthy Mothers/Healthy Child.
S
Subtotal State/Federal/Special $ - 81,128
TOTAL RECEIPTS—equal to Total Expenditures $ 204,82 -
Local Authorized Official Signature Date Beamb Heed Division/Section Signature Date
lnrcW
Finance Officer Signature Date Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
Gcner-id Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET
N.C.Denartment of Environment, Revision Number
Health.and Natural Resources
Division of General Services Division of Health Promotion r
SFY
7 / 97 6 / 98 Activity: COMP. Breast & Cervical Cancer Control
Effective-Date Termination D ate
Contractor: Orange County Health Department ProjectDirector:
Daniel B. Reimer
TOTALBUDGET: S 24,364 S
Screening I Outreach
P. 0.Number P. 0.Number
5452 5453
ITEMDESCRIPTION CLASSIFICATION ITEM Contract Number Contract Number
STATE EXPENDITURES:
E Salaries&Fringe Benefits S A/FR 1000 14,729
X Operating Expenses OP EXP 2000 677
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL, 6100
School Health SCH HLTH 6200 Y t: - k�. F �� g:. ,"�«' x
Clinician CLN 6863 � fs ��
T Laboratory LAB 6862
U Pharmacy Services RX SERV 6865 " fin
R Transfer TXIX _ 6864
E Subtotal State Expend. 24,364
S LOCAL EXPENDITURES: LOCALEXP 9000 0
TOTAL EXPENDITURES—equal to Total Receipts 24,364
LOCALFUNDS: 0
R Appropriation APPROP 101
TXLY TXIX 102 0
E OtherReceipts OTHRREC 103 0
C Subtotal Local Funds 0
E STATE/FEDERAL/SPECIAL
I Screening
P FUND OBJ RCC PROG
T Outreach
S FUND _ OBJ RCC PROG
Subtotal State/Federal/Special 24,364
TOTAL RECEIPTS—equal to Total Expenditures 24,364
LocalAuthorized Official Sianature Date Branch Head Division/SectionSiz nature , Date
Initial
Finance Officer Signature Date .accountant Fiscal ManacernentSisnature Date
Initial
DI•HNR 2948(Revised 7/94)
Gene-al Services Division(Review!96)
LJ
LOCAL HEALTH DEPARTMENT BUDGET
N.C. Department of Environment,
Health, and Natural Resources Revision Number——
Division of General Services
SFY Division of Health Promotion -----
P. O. Number
7 / 97 6 / 98 9 8 5 5 0 2 0 0
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity: Adult Health
Project Director: Daniel 8. Reimer Total Budget: $ 53,502
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 5,502
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
N School Health 8C '
D Clinician CLN 6863
I
Laboratory LAB 6862
T Pharmacy Services RX SERV 6865
U Transfer TXIX
R Subtotal State Expend. $ 5,502
E LOCAL EXPENDITURES: LOCAL EX? 9000
S TOTAL EXPENDITURES —equal to Total Receipts $-
LOCAL FUNDS: 0
R Appropriation APPROP 101
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 0
C $ o
Subtotal Local Funds
E STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 5,502
T
S $ 5,502
Subtotal State/Federal/Special
TOTAL RECEIPTS —equal to Total Expenditures $ 5,502
Local Authorized Official Signature Date B��� Division/Section Signature Date
Finance Officer Signature Date A� Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 30
N.C. Department of Environment,
Health, and Natural Resources Revision Number
Division of General Services
SFY Division of Health Promotion
P. O. Number
7 / 97 6 / 98 9 8 5 5 5 5 1 0 6 8
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity: Health Promotion
Project Director: Daniel B. Reimer Total Budget:$ 25,516
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 22,116
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health NCH T �2 ` .. .. . :: r
D Clinician
I
Laboratory LAIC
T Pharmacy Services RX SERA` frB6 ;. °
U Transfer TXIX .
R Subtotal State Expend. $ 22,116
E LOCAL EXPENDITURES: LOCAL EXP 9000 3,400
S TOTAL EXPENDITURES—equal to Total Receipts $ 25,516
LOCAL FUNDS:
R Appropriation APPROP 101 p
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 3,400
C
E Subtotal Local Funds $ 3,400
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHt1B 22,116
T
S
Subtotal State/Federal/Special $ 22,116
TOTAL RECEIPTS—equal to Total Expenditures $ 25,516
Local Authorized Official Signature Date a x+H� Division/Section Signature Date
Finance Officer Signature Date A un t Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 31
N.C. Depar—ent of Environment,
Health, and Natural Resources Revision Number_ —
Division of General Services
SFY Division of Maternal and Child Health ————P. O. Number
7 / 97 6 / 98 9 8 5 7 1. 5. 0 0, 6 8
Effec--,-e Date Termination Date Contract Number
Orange County Health Department P,�� Immunization Action Plan
Contractor: Activity:
Project Dire---or: Daniel B. Reimer Total Budget: $ 24,369
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
diaries 6z Fringe Benefits SA/FR 1000 17,560
X Operating Expenses OP EXP 2000 6,809
P Purchase of Equipment EQUIP 5000
E General Contracted or
Purchased Services GENERAL 6100
N
Sczool Health .
D
Clinician
I
Pharmacy Services V _..
U T:ansfer TXIX ;:;.>;:::::::>::>:
........ $ .....
:...::.......: .:...:
R Subtotal State Expend. $ 24,369
E LOC.-L EXPENDITURES: LOCAL EXP 9000 0
S TOTAL EXPENDITURES—equal to Total Receipts $ 24,369
LOC.-J-FUNDS:
R A.-propriation APPROP 101 0
E T-!x TXIX 102 0
C lzer Receipts OTHR REC 103 0
C
Subtotal Local Funds $
E
STA?--/FEDERAL/SPECIAL FUNDS:
I
P
T
S
Subtotal State/Federal/Special $ 24,369
TOTAL RECEIPTS —equal to Total Expenditures $ 24,369
Local Aul7orized Official Signature Date BrAwh Hod Division/Section Signature Date
Finance Cifficer Signature Date Aem =' Fiscal Management Signature Date
DEHNR 294,s(Revised Z/93)
General Sermon Division(Review 2/94)